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

Abstract: BackgroundDeviating 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.AimTranslate, test and evaluate the NEWS in a Swedish hospital setting.MethodsStudy 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.ResultsThe 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.ConclusionThe Swedish translated NEWS is a sound “track and trigger” scale to identify high-risk patients at risk of SAEs in Swedish hospital settings.