Comparison of Early Warning Scoring Systems for Hospitalized Patients With and Without Infection at Risk for...

Area of Science:

• Clinical Medicine
• Healthcare Research
• Patient Safety

Background:

• Existing early warning systems (EWS) for general inpatients and those with suspected infections outside the ICU have incompletely characterized relative performance.
• Accurate risk stratification is crucial for timely intervention and improved patient outcomes in hospitalized populations.

Purpose of the Study:

• To compare the performance of five common points-based risk scoring tools in identifying hospitalized patients at risk for death or ICU transfer.
• To evaluate these tools across all inpatients, including those with and without suspected infections.

Main Methods:

• Retrospective analysis of prospectively collected data from 21 California and 7 Illinois hospitals (2006-2018).
• Inclusion of 773,477 patients in California and 713,786 in Illinois, all adult inpatients outside the ICU.
• Comparison of National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), Between the Flags (BTF), Quick Sequential Sepsis-Related Organ Failure Assessment (qSOFA), and Systemic Inflammatory Response Syndrome (SIRS) using Area Under the Receiver Operating Characteristic Curves (AUCs) for mortality and ICU transfer/mortality.

Main Results:

• The NEWS showed the highest discrimination for mortality (AUC 0.87 in California, 0.86 in Illinois).
• NEWS outperformed SIRS and qSOFA at all hospitals, reducing screening needs or increasing adverse outcome identification.
• MEWS, qSOFA, SIRS, and BTF demonstrated progressively lower discrimination compared to NEWS.

Conclusions:

• The National Early Warning Score (NEWS) appears to be the most effective among the evaluated tools for risk stratification in all hospitalized patients, including those with suspected infections.
• Implementing NEWS can aid in identifying high-risk patients, potentially leading to earlier interventions and improved mortality outcomes.
• These findings support the broader adoption of NEWS for inpatient risk assessment.