Predictive value of the New Zealand Early Warning Score for early mortality in low-acuity patients discharged at scene by paramedics: an observational study
Objectives The utility of New Zealand Early Warning Score (NZEWS) for prediction of adversity in low-acuity patients discharged at scene by paramedics has not been investigated. The objective of this study was to evaluate the association between the NZEWS risk-assessment tool and adverse outcomes of...
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BMJ Publishing Group
2022-07-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/7/e058462.full |
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| author | Bridget Dicker Verity Frances Todd Tony Smith Andy Swain Graham Howie Melanie Moylan Aroha Brett |
| author_facet | Bridget Dicker Verity Frances Todd Tony Smith Andy Swain Graham Howie Melanie Moylan Aroha Brett |
| author_sort | Bridget Dicker |
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| description | Objectives The utility of New Zealand Early Warning Score (NZEWS) for prediction of adversity in low-acuity patients discharged at scene by paramedics has not been investigated. The objective of this study was to evaluate the association between the NZEWS risk-assessment tool and adverse outcomes of early mortality or ambulance reattendance within 48 hours in low-acuity, prehospital patients not transported by ambulance.Design A retrospective cohort study.Setting Prehospital emergency medical service provided by St John New Zealand over a 2-year period (1 July 2016 through 30 June 2018).Participants 83 171 low-acuity, adult patients who were attended by an ambulance and discharged at scene. Of these, 41 406 had sufficient recorded data to calculate an NZEWS.Primary and secondary outcome(s) and measure(s) Binary logistic regression modelling was used to investigate the association between the NZEWS and adverse outcomes of reattendance within 48 hours, mortality within 2 days, mortality within 7 days and mortality within 30 days.Results An NZEWS greater than 0 was significantly associated with all adverse outcomes studied (p<0.01), compared with the reference group (NZEWS=0). There was a startling correlation between 2-day, 7-day and 30-day mortality and higher early warning scores; the odds of 2-day mortality in patients with an early warning score>10 was 70 times that of those scoring 0 (adjusted OR 70.64, 95% CI: 30.73 to 162.36). The best predictability for adverse outcome was observed for 2-day and 7-day mortality, with moderate area under the receiver operating characteristic curve scores of 0.78 (95% CI: 0.73 to 0.82) and 0.74 (95% CI: 0.71 to 0.77), respectively.Conclusions Adverse outcomes in low-acuity non-transported patients show a significant association with risk prediction by the NZEWS. There was a very high association between large early warning scores and 2-day mortality in this patient group. These findings suggest that NZEWS has significant utility for decision support and improving safety when determining the appropriateness of discharging low-acuity patients at the scene. |
| format | Article |
| id | doaj-art-7338e51e9b4d4811b715409ddeba7388 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-7338e51e9b4d4811b715409ddeba73882025-01-30T23:45:10ZengBMJ Publishing GroupBMJ Open2044-60552022-07-0112710.1136/bmjopen-2021-058462Predictive value of the New Zealand Early Warning Score for early mortality in low-acuity patients discharged at scene by paramedics: an observational studyBridget Dicker0Verity Frances Todd1Tony Smith2Andy Swain3Graham Howie4Melanie Moylan5Aroha Brett64Clinical Audit and Research, Clinical Evaluation, Research and Insights, Hato Hone St John, Auckland, New Zealand2 Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Auckland, New Zealand3Sheffield Hallam University, Sheffield, UK2 Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Auckland, New Zealand1 St John New Zealand (Hato Hone Aotearoa), Auckland, New Zealand3 Department of Biostatistics and Epidemiology, Auckland University of Technology, Auckland, New Zealand1 St John New Zealand (Hato Hone Aotearoa), Auckland, New ZealandObjectives The utility of New Zealand Early Warning Score (NZEWS) for prediction of adversity in low-acuity patients discharged at scene by paramedics has not been investigated. The objective of this study was to evaluate the association between the NZEWS risk-assessment tool and adverse outcomes of early mortality or ambulance reattendance within 48 hours in low-acuity, prehospital patients not transported by ambulance.Design A retrospective cohort study.Setting Prehospital emergency medical service provided by St John New Zealand over a 2-year period (1 July 2016 through 30 June 2018).Participants 83 171 low-acuity, adult patients who were attended by an ambulance and discharged at scene. Of these, 41 406 had sufficient recorded data to calculate an NZEWS.Primary and secondary outcome(s) and measure(s) Binary logistic regression modelling was used to investigate the association between the NZEWS and adverse outcomes of reattendance within 48 hours, mortality within 2 days, mortality within 7 days and mortality within 30 days.Results An NZEWS greater than 0 was significantly associated with all adverse outcomes studied (p<0.01), compared with the reference group (NZEWS=0). There was a startling correlation between 2-day, 7-day and 30-day mortality and higher early warning scores; the odds of 2-day mortality in patients with an early warning score>10 was 70 times that of those scoring 0 (adjusted OR 70.64, 95% CI: 30.73 to 162.36). The best predictability for adverse outcome was observed for 2-day and 7-day mortality, with moderate area under the receiver operating characteristic curve scores of 0.78 (95% CI: 0.73 to 0.82) and 0.74 (95% CI: 0.71 to 0.77), respectively.Conclusions Adverse outcomes in low-acuity non-transported patients show a significant association with risk prediction by the NZEWS. There was a very high association between large early warning scores and 2-day mortality in this patient group. These findings suggest that NZEWS has significant utility for decision support and improving safety when determining the appropriateness of discharging low-acuity patients at the scene.https://bmjopen.bmj.com/content/12/7/e058462.full |
| spellingShingle | Bridget Dicker Verity Frances Todd Tony Smith Andy Swain Graham Howie Melanie Moylan Aroha Brett Predictive value of the New Zealand Early Warning Score for early mortality in low-acuity patients discharged at scene by paramedics: an observational study BMJ Open |
| title | Predictive value of the New Zealand Early Warning Score for early mortality in low-acuity patients discharged at scene by paramedics: an observational study |
| title_full | Predictive value of the New Zealand Early Warning Score for early mortality in low-acuity patients discharged at scene by paramedics: an observational study |
| title_fullStr | Predictive value of the New Zealand Early Warning Score for early mortality in low-acuity patients discharged at scene by paramedics: an observational study |
| title_full_unstemmed | Predictive value of the New Zealand Early Warning Score for early mortality in low-acuity patients discharged at scene by paramedics: an observational study |
| title_short | Predictive value of the New Zealand Early Warning Score for early mortality in low-acuity patients discharged at scene by paramedics: an observational study |
| title_sort | predictive value of the new zealand early warning score for early mortality in low acuity patients discharged at scene by paramedics an observational study |
| url | https://bmjopen.bmj.com/content/12/7/e058462.full |
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