Efficacy of prehospital National Early Warning Score to predict outpatient disposition at an emergency department of a Japanese tertiary hospital: a retrospective study
Objectives The National Early Warning Score (NEWS) was originally developed to assess hospitalised patients in the UK. We examined whether the NEWS could be applied to patients transported by ambulance in Japan.Design This retrospective study assessed patients and calculated the NEWS from paramedic...
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BMJ Publishing Group
2020-06-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/6/e034602.full |
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| author | Jumpei Tsukuda Shigeki Fujitani Kenichiro Morisawa Nobuhiko Shimozawa Yasuhiko Taira Tomohiro Shinozaki Takuro Endo Toru Yoshida Takako Motohashi Hsiang-Chin Hsu Shunsuke Fukuda Takaki Naito |
| author_facet | Jumpei Tsukuda Shigeki Fujitani Kenichiro Morisawa Nobuhiko Shimozawa Yasuhiko Taira Tomohiro Shinozaki Takuro Endo Toru Yoshida Takako Motohashi Hsiang-Chin Hsu Shunsuke Fukuda Takaki Naito |
| author_sort | Jumpei Tsukuda |
| collection | DOAJ |
| description | Objectives The National Early Warning Score (NEWS) was originally developed to assess hospitalised patients in the UK. We examined whether the NEWS could be applied to patients transported by ambulance in Japan.Design This retrospective study assessed patients and calculated the NEWS from paramedic records. Emergency department (ED) disposition data were categorised into the following groups: discharged from the ED, admitted to the ward, admitted to the intensive care unit (ICU) or died in the ED. The predictive performance of NEWS for patient disposition was assessed using receiver operating characteristic curve analysis. Patient dispositions were compared among NEWS-based categories after adjusting for age, sex and presence of traumatic injury.Setting A tertiary hospital in Japan.Participants Overall, 2847 patients transported by ambulance between April 2017 and March 2018 were included.Results The mean (±SD) NEWS differed significantly among patients discharged from the ED (n=1330, 3.7±2.9), admitted to the ward (n=1263, 6.3±3.8), admitted to the ICU (n=232, 9.4±4.0) and died in the ED (n=22, 11.7±2.9) (p<0.001). The prehospital NEWS C-statistics (95% CI) for admission to the ward, admission to the ICU or death in the ED; admission to the ICU or death in the ED; and death in the ED were 0.73 (0.72–0.75), 0.81 (0.78–0.83) and 0.90 (0.87–0.93), respectively. After adjusting for age, sex and trauma, the OR (95% CI) of admission to the ICU or death in the ED for the high-risk (NEWS ≥7) and medium-risk (NEWS 5–6) categories was 13.8 (8.9–21.6) and 4.2 (2.5–7.1), respectively.Conclusion The findings from this Japanese tertiary hospital setting showed that prehospital NEWS could be used to identify patients at a risk of adverse outcomes. NEWS stratification was strongly correlated with patient disposition. |
| format | Article |
| id | doaj-art-91797ac0e37245349a2e6880fa83ae80 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-06-01 |
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| series | BMJ Open |
| spelling | doaj-art-91797ac0e37245349a2e6880fa83ae802025-08-20T01:53:21ZengBMJ Publishing GroupBMJ Open2044-60552020-06-0110610.1136/bmjopen-2019-034602Efficacy of prehospital National Early Warning Score to predict outpatient disposition at an emergency department of a Japanese tertiary hospital: a retrospective studyJumpei Tsukuda0Shigeki Fujitani1Kenichiro Morisawa2Nobuhiko Shimozawa3Yasuhiko Taira4Tomohiro Shinozaki5Takuro Endo6Toru Yoshida7Takako Motohashi8Hsiang-Chin Hsu9Shunsuke Fukuda10Takaki Naito11Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan1 Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, Kawasaki, Japan1 Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, Kawasaki, Japan1 Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, Kawasaki, Japan1 Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, Kawasaki, JapanDepartment of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Katsushika-ku, Tokyo, JapanSt. Mariana University School of MedicineNTT Docomo Red Hurricanes Rugby Club, Osaka, JapanDepartment of Preventive Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, JapanEmergency Medicine, National Cheng Kung University Hospital, Tainan, TaiwanDepartment of Emergency and Critical Care Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, JapanDepartment of Emergency and Critical Care Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, JapanObjectives The National Early Warning Score (NEWS) was originally developed to assess hospitalised patients in the UK. We examined whether the NEWS could be applied to patients transported by ambulance in Japan.Design This retrospective study assessed patients and calculated the NEWS from paramedic records. Emergency department (ED) disposition data were categorised into the following groups: discharged from the ED, admitted to the ward, admitted to the intensive care unit (ICU) or died in the ED. The predictive performance of NEWS for patient disposition was assessed using receiver operating characteristic curve analysis. Patient dispositions were compared among NEWS-based categories after adjusting for age, sex and presence of traumatic injury.Setting A tertiary hospital in Japan.Participants Overall, 2847 patients transported by ambulance between April 2017 and March 2018 were included.Results The mean (±SD) NEWS differed significantly among patients discharged from the ED (n=1330, 3.7±2.9), admitted to the ward (n=1263, 6.3±3.8), admitted to the ICU (n=232, 9.4±4.0) and died in the ED (n=22, 11.7±2.9) (p<0.001). The prehospital NEWS C-statistics (95% CI) for admission to the ward, admission to the ICU or death in the ED; admission to the ICU or death in the ED; and death in the ED were 0.73 (0.72–0.75), 0.81 (0.78–0.83) and 0.90 (0.87–0.93), respectively. After adjusting for age, sex and trauma, the OR (95% CI) of admission to the ICU or death in the ED for the high-risk (NEWS ≥7) and medium-risk (NEWS 5–6) categories was 13.8 (8.9–21.6) and 4.2 (2.5–7.1), respectively.Conclusion The findings from this Japanese tertiary hospital setting showed that prehospital NEWS could be used to identify patients at a risk of adverse outcomes. NEWS stratification was strongly correlated with patient disposition.https://bmjopen.bmj.com/content/10/6/e034602.full |
| spellingShingle | Jumpei Tsukuda Shigeki Fujitani Kenichiro Morisawa Nobuhiko Shimozawa Yasuhiko Taira Tomohiro Shinozaki Takuro Endo Toru Yoshida Takako Motohashi Hsiang-Chin Hsu Shunsuke Fukuda Takaki Naito Efficacy of prehospital National Early Warning Score to predict outpatient disposition at an emergency department of a Japanese tertiary hospital: a retrospective study BMJ Open |
| title | Efficacy of prehospital National Early Warning Score to predict outpatient disposition at an emergency department of a Japanese tertiary hospital: a retrospective study |
| title_full | Efficacy of prehospital National Early Warning Score to predict outpatient disposition at an emergency department of a Japanese tertiary hospital: a retrospective study |
| title_fullStr | Efficacy of prehospital National Early Warning Score to predict outpatient disposition at an emergency department of a Japanese tertiary hospital: a retrospective study |
| title_full_unstemmed | Efficacy of prehospital National Early Warning Score to predict outpatient disposition at an emergency department of a Japanese tertiary hospital: a retrospective study |
| title_short | Efficacy of prehospital National Early Warning Score to predict outpatient disposition at an emergency department of a Japanese tertiary hospital: a retrospective study |
| title_sort | efficacy of prehospital national early warning score to predict outpatient disposition at an emergency department of a japanese tertiary hospital a retrospective study |
| url | https://bmjopen.bmj.com/content/10/6/e034602.full |
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