Ability of prehospital NEWS to predict 1-day and 7-day mortality is reduced in older adult patients. Issue 12 (11th May 2021)

• Record Type: Journal Article
• Authors: Pirneskoski, Jussi; Lääperi, Mitja; Kuisma, Markku; Olkkola, Klaus T; Nurmi, Jouni
• Is Part Of: Emergency medicine journal. Volume 38:Issue 12(2021)
• Page Start: 913
• Page End: 918
• Publication Date: 2021-05-11
• Subjects: prehospital care -- clinical management -- clinical assessment -- emergency ambulance systems; Emergency medicine -- Periodicals; 616.02505
• DOI: 10.1136/emermed-2019-209400
• Languages: English
• ISSNs: 1472-0205

Abstract

Abstract : Background: National Early Warning Score (NEWS) does not include age as a parameter despite age is a significant independent risk factor of death. The aim of this study was to examine whether age has an effect on predictive performance of short-term mortality of NEWS in a prehospital setting. We also evaluated whether adding age as an additional parameter to NEWS improved its short-term mortality prediction. Methods: We calculated NEWS scores from retrospective prehospital electronic patient record data for patients 18 years or older with sufficient prehospital data to calculate NEWS. We used area under receiver operating characteristic (AUROC) to analyse the predictive performance of NEWS for 1 and 7 day mortalities with increasing age in three different age groups: <65 years, 65–79 years and ≥80 years. We also explored the ORs for mortality of different NEWS parameters in these age groups. We added age to NEWS as an additional parameter and evaluated its effect on predictive performance. Results: We analysed data from 35 800 ambulance calls. Predictive performance for 7-day mortality of NEWS decreased with increasing age: AUROC (95% CI) for 1-day mortality was 0.876 (0.848 to 0.904), 0.824 (0.794 to 0.854) and 0.820 (0.788 to 0.852) for first, second and third age groups, respectively. AUROC for 7-day mortality had a similar trend. Addition of age as an additional parameter to NEWS improved its ability to predict short-term mortality when assessed with continuous Net Reclassification Improvement. Conclusions: Age should be considered as an additional parameter to NEWS, as it improved its performance in predicting short-term mortality in this prehospital cohort.