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Utilisation of the National Early Warning Score (NEWS) and Assessment of Patient Outcomes Following Cardiac Surgery
Abiah Jacob1, Azmi Qudsi1, Niraj S Kumar1,2
1Department of Cardiac Surgery, Barts Heart Centre, St. Bartholomew's Hospital, London EC1A 7BE, UK.
Insights
The National Early Warning Score (NEWS) threshold of 5 did not predict deterioration in cardiac surgery patients. However, Critical Care Outreach Team (CCOT) review significantly reduced in-hospital mortality, suggesting tailored scores may improve outcomes.
Area of Science:
- Critical Care Medicine
- Cardiovascular Surgery
- Health Services Research
Background:
- The National Early Warning Score (NEWS) is used to standardize acute illness severity assessment in the NHS.
- A NEWS trigger score of 5 or more is recommended for Critical Care Outreach Team (CCOT) review.
- The effectiveness of this threshold in predicting deterioration and outcomes in cardiac surgery patients is not well-established.
Purpose of the Study:
- To evaluate if a NEWS 2 trigger score of 5 or more accurately predicts deterioration in adult cardiac surgery patients.
- To compare patient outcomes based on NEWS 2 parameters and CCOT review.
- To determine if tailoring the NEWS threshold could improve outcomes in this specific cohort.
Main Methods:
- Retrospective analysis of adult cardiac surgery patients from October 2019 to December 2021.
- Comparison of NEWS 2 parameters triggering CCOT referrals versus those below a score of 5.
- Evaluation of patient outcomes including transfers to higher care, cardiac arrest, emergency resternotomy, and in-hospital mortality.
Main Results:
- Of 3710 patients, 162 (4.4%) triggered 193 CCOT calls, with a mean NEWS 2 score of 6.14.
- Low SpO2 and oxygen therapy were common triggers; 34 activations (20.98%) were from patients with NEWS 2 < 5.
- CCOT review was associated with significantly higher in-hospital mortality (10.5% vs. 3.9%, p < 0.001), while NEWS 2 score (<5 vs. ≥5) showed no significant difference (17.6% vs. 8.6%, p = 0.126).
Conclusions:
- The NEWS 2 threshold of 5 did not differentiate in-hospital mortality in cardiac surgery patients.
- CCOT review was significantly associated with in-hospital mortality, indicating its importance in managing at-risk patients.
- Tailoring the NEWS threshold for cardiac surgical patients, alongside clinical judgment, may enhance patient outcomes.
Abstract:
Objectives: The national early warning score (NEWS) was introduced to improve the detection of, and standardise the assessment of, the severity of acute illness in the National Health Service (NHS). We assessed whether the recommended threshold trigger score of 5 or more in a Critical Care Outreach Team (CCOT) review could accurately predict patients at risk of deterioration following cardiac surgery and patient outcomes. Methods: We investigated adult cardiac surgery patients between October 2019 and December 2021. NEWS 2 parameters triggering CCOT referrals and NEWS 2 parameters < 5 versus ≥5 were compared, and the resulting patient outcomes were evaluated. Results: Over this period, 3710 patients underwent surgery, of whom 162 (4.4%) initiated 193 calls to the CCOT. The mean number of NEWS 2 parameters on CCOT activation was 6.14 ± 2.43 (NEWS 0-16); 34 (20.98%) activations were from patients with NEWS 2 < 5. Low oxygen saturation (SpO2) (59.3%) and oxygen therapy (83.3%) were the most common physiological parameters raising the score. CCOT activations led to 38 transfers from the ward to the high-dependency unit (HDU) and 18 transfers to the intensive therapy unit (ITU). Cardiac arrest calls were initiated in 12 (7.40%) patients and two culminated in death. Fourteen (8.64%) had emergency resternotomy. The in-hospital mortality rate was 10.5% (17/162) in patients referred to CCOT versus 3.9% (139/3548) in patients who were not (p < 0.001). The in-hospital mortality in patients with NEWS 2 < 5 vs. NEWS ≥ 5 was 17.6% (6/34) versus 8.6% (11/128) (p = 0.126). Conclusions: There was no difference in in-hospital mortality in patients below or above a NEWS 2 of 5, but there was a significant difference in in-hospital mortality in patients reviewed by the CCOT (p < 0.001). Tailoring the threshold score specifically for the cardiac surgical cohort, in conjunction with clinician involvement, may improve outcomes.
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