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The National Early Warning Score (NEWS) - Testing and evaluation in a Swedish setting

Spångfors, Martin LU (2020) In Lund University, Faculty of Medicine Doctoral Dissertation Series
Abstract
Background
Deviating vital signs have been known to precede Serious Adverse Events (SAEs) like In-Hospital Cardiac Arrest (IHCA), unplanned Intensive Care Unit (ICU) admission or unexpected death for more than a decade but still the recognition of these deteriorating patients is poor.
The British National Early Warning Score (NEWS) is a ‘‘track and trigger’’ scale designed to assess in-hospital patients’ vital signs and detect clinical deterioration.
Aim
Translate, test and evaluate the NEWS in a Swedish hospital setting.
Methods
Study I: The NEWS was translated and culturally adapted into Swedish and its association with the need for intensive care was investigated by a review of the rapid response team’s (RRT)... (More)
Background
Deviating vital signs have been known to precede Serious Adverse Events (SAEs) like In-Hospital Cardiac Arrest (IHCA), unplanned Intensive Care Unit (ICU) admission or unexpected death for more than a decade but still the recognition of these deteriorating patients is poor.
The British National Early Warning Score (NEWS) is a ‘‘track and trigger’’ scale designed to assess in-hospital patients’ vital signs and detect clinical deterioration.
Aim
Translate, test and evaluate the NEWS in a Swedish hospital setting.
Methods
Study I: The NEWS was translated and culturally adapted into Swedish and its association with the need for intensive care was investigated by a review of the rapid response team’s (RRT) medical records in a university hospital.
Study II: The associations between in-hospital or 30-day mortality and the NEWS risk categories low, medium and high were analyzed in a vital signs database.
Study III: The 24 hours preceding an in-hospital cardiac arrest were divided into four timespans and the NEWS was analyzed by a medical record review of 127:254 matched case-control patients.
Study IV: A web-based questionnaire was designed to describe Registered Nurses’ (RN) perceptions and experiences of and barriers for using the NEWS in relation to their work experience and medical affiliation.
Results
The Swedish translated NEWS had an excellent inter-rater reliability and the median score for patients admitted to the ICU were higher than for those who were not. AUC for discriminating admittance to the ICU was fair.
Patients classified as medium or high risk by the NEWS experienced a two- or threefold increase, respectively, in odds of in-hospital death or 30-day mortality compared to low‐risk patients.
Patients suffering an IHCA had higher NEWS than their matched controls. The NEWS high-risk category was associated with a three- to fourfold increase in odds of IHCA compared to low-risk.
In general, RNs perceived the NEWS as a useful tool, supporting their gut feelings about an unstable patient. Barriers to the NEWS were found in doctors and the most experienced RNs.
Conclusion
The Swedish translated NEWS is a sound “track and trigger” scale to identify high-risk patients at risk of SAEs in Swedish hospital settings.
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Abstract (Swedish)
Background
Deviating vital signs have been known to precede Serious Adverse Events (SAEs) like In-Hospital Cardiac Arrest (IHCA), unplanned Intensive Care Unit (ICU) admission or unexpected death for more than a decade but still the recognition of these deteriorating patients is poor.
The British National Early Warning Score (NEWS) is a ‘‘track and trigger’’ scale designed to assess in-hospital patients’ vital signs and detect clinical deterioration.
Aim
Translate, test and evaluate the NEWS in a Swedish hospital setting.
Methods
Study I: The NEWS was translated and culturally adapted into Swedish and its association with the need for intensive care was investigated by a review of the rapid response team’s (RRT)... (More)
Background
Deviating vital signs have been known to precede Serious Adverse Events (SAEs) like In-Hospital Cardiac Arrest (IHCA), unplanned Intensive Care Unit (ICU) admission or unexpected death for more than a decade but still the recognition of these deteriorating patients is poor.
The British National Early Warning Score (NEWS) is a ‘‘track and trigger’’ scale designed to assess in-hospital patients’ vital signs and detect clinical deterioration.
Aim
Translate, test and evaluate the NEWS in a Swedish hospital setting.
Methods
Study I: The NEWS was translated and culturally adapted into Swedish and its association with the need for intensive care was investigated by a review of the rapid response team’s (RRT) medical records in a university hospital.
Study II: The associations between in-hospital or 30-day mortality and the NEWS risk categories low, medium and high were analyzed in a vital signs database.
Study III: The 24 hours preceding an in-hospital cardiac arrest were divided into four timespans and the NEWS was analyzed by a medical record review of 127:254 matched case-control patients.
Study IV: A web-based questionnaire was designed to describe Registered Nurses’ (RN) perceptions and experiences of and barriers for using the NEWS in relation to their work experience and medical affiliation.
Results
The Swedish translated NEWS had an excellent inter-rater reliability and the median score for patients admitted to the ICU were higher than for those who were not. AUC for discriminating admittance to the ICU was fair.
Patients classified as medium or high risk by the NEWS experienced a two- or threefold increase, respectively, in odds of in-hospital death or 30-day mortality compared to low‐risk patients.
Patients suffering an IHCA had higher NEWS than their matched controls. The NEWS high-risk category was associated with a three- to fourfold increase in odds of IHCA compared to low-risk.
In general, RNs perceived the NEWS as a useful tool, supporting their gut feelings about an unstable patient. Barriers to the NEWS were found in doctors and the most experienced RNs.
Conclusion
The Swedish translated NEWS is a sound “track and trigger” scale to identify high-risk patients at risk of SAEs in Swedish hospital settings.
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Please use this url to cite or link to this publication:
author
supervisor
opponent
  • professor Rasmussen, Lars Simon, University of Copenhagen
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Early Warning Score, Critical Care, National Early Warning Score, in-hospital cardiac arrest, Patient Safety, Critical care outreach
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
issue
2020:2
pages
93 pages
publisher
Lund University, Faculty of Medicine
defense location
Föreläsningssal Hanö, Kristianstads sjukhus.
defense date
2020-03-06 13:00:00
external identifiers
  • scopus:85077941238
ISSN
1652-8220
ISBN
978-91-7619-862-9
language
English
LU publication?
yes
id
bf57e2cb-dc40-43d2-bbed-6e1de5ed52a7
date added to LUP
2020-01-23 20:19:32
date last changed
2020-07-08 05:11:18
@phdthesis{bf57e2cb-dc40-43d2-bbed-6e1de5ed52a7,
  abstract     = {Background<br/>Deviating vital signs have been known to precede Serious Adverse Events (SAEs) like In-Hospital Cardiac Arrest (IHCA), unplanned Intensive Care Unit (ICU) admission or unexpected death for more than a decade but still the recognition of these deteriorating patients is poor.<br/>The British National Early Warning Score (NEWS) is a ‘‘track and trigger’’ scale designed to assess in-hospital patients’ vital signs and detect clinical deterioration.<br/>Aim<br/>Translate, test and evaluate the NEWS in a Swedish hospital setting.<br/>Methods<br/>Study I: The NEWS was translated and culturally adapted into Swedish and its association with the need for intensive care was investigated by a review of the rapid response team’s (RRT) medical records in a university hospital.<br/>Study II: The associations between in-hospital or 30-day mortality and the NEWS risk categories low, medium and high were analyzed in a vital signs database. <br/>Study III: The 24 hours preceding an in-hospital cardiac arrest were divided into four timespans and the NEWS was analyzed by a medical record review of 127:254 matched case-control patients.<br/>Study IV: A web-based questionnaire was designed to describe Registered Nurses’ (RN) perceptions and experiences of and barriers for using the NEWS in relation to their work experience and medical affiliation.<br/>Results<br/>The Swedish translated NEWS had an excellent inter-rater reliability and the median score for patients admitted to the ICU were higher than for those who were not. AUC for discriminating admittance to the ICU was fair. <br/>Patients classified as medium or high risk by the NEWS experienced a two- or threefold increase, respectively, in odds of in-hospital death or 30-day mortality compared to low‐risk patients.<br/>Patients suffering an IHCA had higher NEWS than their matched controls. The NEWS high-risk category was associated with a three- to fourfold increase in odds of IHCA compared to low-risk.<br/>In general, RNs perceived the NEWS as a useful tool, supporting their gut feelings about an unstable patient. Barriers to the NEWS were found in doctors and the most experienced RNs.<br/>Conclusion<br/>The Swedish translated NEWS is a sound “track and trigger” scale to identify high-risk patients at risk of SAEs in Swedish hospital settings.<br/>},
  author       = {Spångfors, Martin},
  isbn         = {978-91-7619-862-9},
  issn         = {1652-8220},
  language     = {eng},
  number       = {2020:2},
  publisher    = {Lund University, Faculty of Medicine},
  school       = {Lund University},
  series       = {Lund University, Faculty of Medicine Doctoral Dissertation Series},
  title        = {The National Early Warning Score (NEWS) - Testing and evaluation in a Swedish setting},
  url          = {https://lup.lub.lu.se/search/ws/files/75424033/Martin_Sp_ngfors_web.pdf},
  year         = {2020},
}