Physiological deterioration prior to in-hospital cardiac arrest: What does the National Early Warning Score-2 miss?

Aim: To determine the frequency with which the National Early Warning Score-2 (NEWS-2) fails to detect physiological deterioration preceding in-hospital cardiac arrest (IHCA). Methods: We conducted a retrospective observational study of all adult patients (age ≥ 18) who had suffered an IHCA between...

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Main Authors: Sherif Gonem, Daniella Draicchio, Ayad Mohamed, Sally Wood, Kelly Shiel, Steve Briggs, Tricia M McKeever, Dominick Shaw
Format: Article
Language:English
Published: Elsevier 2024-12-01
Series:Resuscitation Plus
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Online Access:http://www.sciencedirect.com/science/article/pii/S266652042400239X
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author Sherif Gonem
Daniella Draicchio
Ayad Mohamed
Sally Wood
Kelly Shiel
Steve Briggs
Tricia M McKeever
Dominick Shaw
author_facet Sherif Gonem
Daniella Draicchio
Ayad Mohamed
Sally Wood
Kelly Shiel
Steve Briggs
Tricia M McKeever
Dominick Shaw
author_sort Sherif Gonem
collection DOAJ
description Aim: To determine the frequency with which the National Early Warning Score-2 (NEWS-2) fails to detect physiological deterioration preceding in-hospital cardiac arrest (IHCA). Methods: We conducted a retrospective observational study of all adult patients (age ≥ 18) who had suffered an IHCA between 1st July 2019 and 31st December 2021 in two large acute hospitals located in an urban centre (Nottingham, UK). Clinical observations and case notes were examined for the period leading up to IHCA events to determine if there was evidence of physiological deterioration which warranted an urgent patient assessment, whether NEWS-2 was triggered, and whether an urgent assessment actually took place. Results: Urgent assessment was indicated in the lead-up to 126/374 (33.7 %) IHCA cases, and NEWS-2 failed to trigger in 20 of these cases (15.9 %). An urgent assessment took place in 89/106 (84.0 %) cases where NEWS-2 was triggered, and 13/20 (65.0 %) cases where NEWS-2 was not triggered, with the difference in proportions being statistically significant (p = 0.048). Half of cases in which NEWS-2 missed a physiological deterioration were related to a new or rising oxygen requirement. Conclusions: A significant proportion of IHCA events are preceded by clinically important abnormalities in vital signs which are not detected by NEWS-2. This may be a causative factor in some failure-to-rescue events.
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spelling doaj-art-6f4738b3c8af41cabcee5fd08e5444c42025-08-20T02:32:21ZengElsevierResuscitation Plus2666-52042024-12-012010078810.1016/j.resplu.2024.100788Physiological deterioration prior to in-hospital cardiac arrest: What does the National Early Warning Score-2 miss?Sherif Gonem0Daniella Draicchio1Ayad Mohamed2Sally Wood3Kelly Shiel4Steve Briggs5Tricia M McKeever6Dominick Shaw7Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK; Corresponding author at: Department of Respiratory Medicine, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK.Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UKDepartment of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UKRecognise and Rescue, Nottingham University Hospitals NHS Trust, Nottingham, UKRecognise and Rescue, Nottingham University Hospitals NHS Trust, Nottingham, UKDigital and Information, Nottingham University Hospitals NHS Trust, Nottingham, UKNIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UKNIHR Leicester Biomedical Research Centre, School of Medicine, University of Leicester, Leicester, UKAim: To determine the frequency with which the National Early Warning Score-2 (NEWS-2) fails to detect physiological deterioration preceding in-hospital cardiac arrest (IHCA). Methods: We conducted a retrospective observational study of all adult patients (age ≥ 18) who had suffered an IHCA between 1st July 2019 and 31st December 2021 in two large acute hospitals located in an urban centre (Nottingham, UK). Clinical observations and case notes were examined for the period leading up to IHCA events to determine if there was evidence of physiological deterioration which warranted an urgent patient assessment, whether NEWS-2 was triggered, and whether an urgent assessment actually took place. Results: Urgent assessment was indicated in the lead-up to 126/374 (33.7 %) IHCA cases, and NEWS-2 failed to trigger in 20 of these cases (15.9 %). An urgent assessment took place in 89/106 (84.0 %) cases where NEWS-2 was triggered, and 13/20 (65.0 %) cases where NEWS-2 was not triggered, with the difference in proportions being statistically significant (p = 0.048). Half of cases in which NEWS-2 missed a physiological deterioration were related to a new or rising oxygen requirement. Conclusions: A significant proportion of IHCA events are preceded by clinically important abnormalities in vital signs which are not detected by NEWS-2. This may be a causative factor in some failure-to-rescue events.http://www.sciencedirect.com/science/article/pii/S266652042400239XCardiac arrestClinical deteriorationRapid response teamEarly warning scoreVital signs
spellingShingle Sherif Gonem
Daniella Draicchio
Ayad Mohamed
Sally Wood
Kelly Shiel
Steve Briggs
Tricia M McKeever
Dominick Shaw
Physiological deterioration prior to in-hospital cardiac arrest: What does the National Early Warning Score-2 miss?
Resuscitation Plus
Cardiac arrest
Clinical deterioration
Rapid response team
Early warning score
Vital signs
title Physiological deterioration prior to in-hospital cardiac arrest: What does the National Early Warning Score-2 miss?
title_full Physiological deterioration prior to in-hospital cardiac arrest: What does the National Early Warning Score-2 miss?
title_fullStr Physiological deterioration prior to in-hospital cardiac arrest: What does the National Early Warning Score-2 miss?
title_full_unstemmed Physiological deterioration prior to in-hospital cardiac arrest: What does the National Early Warning Score-2 miss?
title_short Physiological deterioration prior to in-hospital cardiac arrest: What does the National Early Warning Score-2 miss?
title_sort physiological deterioration prior to in hospital cardiac arrest what does the national early warning score 2 miss
topic Cardiac arrest
Clinical deterioration
Rapid response team
Early warning score
Vital signs
url http://www.sciencedirect.com/science/article/pii/S266652042400239X
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