Trends in the national early warning score are associated with subsequent mortality - A prospective three-centre observational study with 11,331 general ward patients.

Aim: To investigate whether trends in the NEWS values are associated with patient mortality in general ward patients. Methods: A one-year prospective observational study in three hospitals in Finland. All data on patients' NEWS values during the first three days of general ward admissions were collected. The linear regression model was used to investigate the association of the NEWS trajectories with subsequent mortality. We used three outcome measures: 4-7-day, 4-14-day and 4-21-day mortality rates after the 0-3 days of initial hospitalization, respectively. Results: The study cohort consisted of 11,331 general ward patients. The non-survivors had higher initial NEWS score values in all outcome categories (all p < 0.001). The non-survivors had a rising trajectory in their NEWS values in all the outcome categories, whereas the survivors had a downward trajectory in their NEWS values in all outcome categories (data presented as first- and third-day's median values): an increase from 5.0 to 6.0 vs. a decrease from 1.5 to 1.0 (4-7-day non-survivors vs. survivors), an increase from 4.0 to 5.0 vs. a decrease from 1.5 to 1.0 (4-14-day non-survivors vs. survivors) and an increase from 4.0 to 5.0 vs. a decrease from 1.5 to 1.0 (4-21-day non-survivors vs. survivors). In the linear regression model, these differences in trends were statistically significant in all the outcome categories (p < 0.05). Conclusion: The NEWS score trajectory during the first three days of general ward admission is associated with patient outcome. Further studies are warranted to determine specific thresholds for clinically relevant changes in the NEWS trajectories.