Introduction: The National Early Warning Score 2 (NEWS2) is an international clinical tool, used to promote early detection and prompt intervention to worsening patients, improving medical response and reducing mortality. Despite its extensive validation in the hospital setting, prospective evidence on its application in pre-hospital emergency settings remains scarce.
We aimed to evaluate the performance of the NEWS2 in identifying critical patients in pre-hospital care settings and its behavior over time until hospital admission.
Methods: We performed a prospective single-center cohort study using data from pre-hospital care by a Pre-hospital Emergency Medical Team (PEMT) of a tertiary hospital. NEWS2 was collected from all adult patients eligible upon PEMT’s arrival and upon hospital admission. Patients were further divided and compared according to the decision of patient transference under PEMT supervision (TWPS) to hospital care: TWPS group and not-TWPS group.
Results: 1307 patients (mean age 66 years, 50.4% males) were included in the analysis (n= 788 not-TWPS group, n= 452 TWPS group). Mean NEWS2 at patients’ initial evaluation was statistically different between not-TWPS and TWPS groups (2,73 ± 2,9 vs 6,45 ± 4,17; p<0.0001), with clear segregation of low clinical risk patients (NEWS2<4) in the not-TWPS group (617 patients with NEWS2≤4; 78%) and medium-to-high clinical risk patients in TWES group (291 patients with NEWS≥5; 64%). This difference remained significant between these two groups even when adjusted to the reasons for clinical evaluation, gender, and age (p<0.0001).
NEWS2 also demonstrated good accuracy in predicting patients’ illness severity and need for hospital transference under PEMT supervision (AUROC 0.833; 0.786-0.841; p<0.0001).
Conclusion: NEWS2 appears as a useful clinical tool in patient assessment in pre-hospital medical practice, allowing promptly recognition of severe clinical settings that should motivate hospital transfer under PEMT assistance and intervention, if required, for clinical improvement.

CLINICAL APPLICATION OF NATIONAL EARLY WARNING SCORE 2 (NEWS2) IN PRE-HOSPITAL CARE: A PROSPECTIVE COHORT STUDY

Implementation of the Guidelines - How do we put the new ERC Guidelines into practice?

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