Observational studyBMJ open2019
Combination of the National Early Warning Score (NEWS) and inflammatory biomarkers for early risk stratification in emergency department patients: results of a multinational, observational study.
Observational study in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01768494 (Optimizing Triage and Hospitalisation In Adult General Medical Emergency Patients), which is not on this map. Cited by 23 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Optimizing Triage and Hospitalisation In Adult General Medical Emergency Patients: the TRIAGE Study
Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Performance of universal early warning scores in different patient subgroups and clinical settings: a systematic review.BMJ open · 2021Pooled it
- Prognostic Performance of the Korean Triage and Acuity Scale Combined with the National Early Warning Score for Predicting Mortality and ICU Admission at Emergency Department Triage: A Retrospective Observational Study.Diagnostics (Basel, Switzerland) · 2026Article
- External validation of the International Early Warning Score in non-traumatic emergency department patients: a prospective cohort study.BMC emergency medicine · 2025Observational
- The variable relationship between the National Early Warning Score on admission to hospital, the primary discharge diagnosis, and in-hospital mortality.Internal and emergency medicine · 2025Observational
- Forecasting Mortality Associated Emergency Department Crowding with LightGBM and Time Series Data.Journal of medical systems · 2025Article
- Review
- The Value of Emergency Care Data Set (ECDS) Presentation Codes for Predicting Mortality and Inpatient Admission.Cureus · 2024Article
- Predicting acute clinical deterioration with interpretable machine learning to support emergency care decision making.Scientific reports · 2023Article
- Article
- Predicting patient decompensation from continuous physiologic monitoring in the emergency department.NPJ digital medicine · 2023Article
- Clinical Outcome and Prognosis of a Nosocomial Outbreak of COVID-19.Journal of clinical medicine · 2023Article
- Performance of digital early warning score (NEWS2) in a cardiac specialist setting: retrospective cohort study.BMJ open · 2023Article
- Prognostic value of cardiac biomarkers and National Early Warning Score 2 in acute dyspnoea.Open heart · 2022Article
- Comparing the prehospital NEWS with in-hospital ESI in predicting 30-day severe outcomes in emergency patients.BMC emergency medicine · 2022Observational
- Admission of patients with chest pain and/or breathlessness from the emergency department in relation to risk assessment and copeptin levels - an observational study.Upsala journal of medical sciences · 2022Observational
- Mid-regional pro-adrenomedullin as a predictor of in-hospital mortality in adult patients with COVID-19: a single-centre prospective study.Anaesthesiology intensive therapy · 2022Article
- Predictive Performance of the NEWS‒Lactate and NEWS Towards Mortality or Need for Critical Care Among Patients with Suspicion of Sepsis in the Emergency Department: A Prospective Observational Study.Open access emergency medicine : OAEM · 2022Article
- Development and validation of a scoring system for mortality prediction and application of standardized W statistics to assess the performance of emergency departments.BMC emergency medicine · 2021Article
- Epidemiology and clinical features of common community human coronavirus disease.Journal of thoracic disease · 2021Article
- Retrospective study on the possible existence of a treatment paradox in sepsis scores in the emergency department.BMJ open · 2021Observational
Corrections and comments
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThe National Early Warning Score (NEWS) helps to estimate mortality risk in emergency department (ED) patients. This study aimed to investigate whether the prognostic value of the NEWS at ED admission could be further improved by adding inflammatory blood markers (ie, white cell count (WCC), procalcitonin (PCT) and midregional-proadrenomedullin (MR-proADM).
designSecondary analysis of a multinational, observational study (TRIAGE study, March 2013-October 2014).
settingThree tertiary care centres in France, Switzerland and the USA.
participantsA total of 1303 adult medical patients with complete NEWS data seeking ED care were included in the final analysis. NEWS was calculated retrospectively based on admission data.
main outcome measuresThe primary outcome was all-cause 30-day mortality. Secondary outcome was intensive care unit (ICU) admission. We used multivariate regression analyses to investigate associations of NEWS and blood markers with outcomes and area under the receiver operating curve (AUC) as a measure of discrimination.
resultsOf the 1303 included patients, 54 (4.1%) died within 30 days. The NEWS alone showed fair prognostic accuracy for all-cause 30-day mortality (AUC 0.73), with a multivariate adjusted OR of 1.26 (95% CI 1.13 to 1.40, p<0.001). The AUCs for the prediction of mortality using the inflammatory markers WCC, PCT and MR-proADM were 0.64, 0.71 and 0.78, respectively. Combining NEWS with all three blood markers or only with MR-proADM clearly improved discrimination with an AUC of 0.82 (p=0.002). Combining the three inflammatory markers with NEWS improved prediction of ICU admission (AUC 0.70vs0.65 when using NEWS alone, p=0.006).
conclusionNEWS is helpful in risk stratification of ED patients and can be further improved by the addition of inflammatory blood markers. Future studies should investigate whether risk stratification by NEWS in addition to biomarkers improve site-of-care decision in this patient population. TRIAL REGISTRATION NUMBER: NCT01768494; Post-results.
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