Observational studyBMC emergency medicine2025
External validation of the International Early Warning Score in non-traumatic emergency department patients: a prospective cohort study.
Observational study in BMC emergency medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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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.
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Who cites it
1 citing paper in PubMed.
- Lactate-to-albumin ratio, C-reactive protein-to-albumin ratio, and prognostic nutritional index in acute and critical care: A focused mini-review.World journal of critical care medicine · 2026Review
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundEmergency department (ED) overcrowding has become a global public health concern, underscoring the importance of rapid and reliable risk stratification tools. Early warning scores are widely used to identify patients at risk of deterioration and mortality. The recently developed International Early Warning Score (IEWS), which incorporates age and sex adjustments into the National Early Warning Score (NEWS) model, has shown promising results and has undergone initial external validation in a Danish cohort; however, no prospective external validation has yet been conducted, and broader international validation remains limited. This study aimed to evaluate the performance of IEWS compared with NEWS in predicting in-hospital mortality, 30-day mortality, and ICU admission among adult ED patients.
methodsThis prospective observational cohort study was conducted between July and August 2024 in a tertiary university hospital ED with an annual census of ~ 70,000 visits. Adult patients presenting to the ED were included, while trauma cases, patients without vital signs on arrival, interhospital transfers, and cases with incomplete data were excluded. IEWS and NEWS were calculated at presentation. The primary outcome was all-cause in-hospital mortality; secondary outcomes included 30-day mortality and ICU admission.
resultsA total of 8,666 patients were analyzed. The median age was 40 years (IQR: 26-58), and 51.5% were female. In-hospital mortality was 1.5% (n = 134), and 30-day mortality was 1.9% (n = 163). IEWS demonstrated excellent discriminative ability for in-hospital and 30-day mortality (AUC: 0.944 and 0.930, respectively), and good performance for ICU admission (AUC: 0.876). In contrast, NEWS showed good performance for in-hospital and 30-day mortality (AUC: 0.884 and 0.848, respectively) and moderate performance for ICU admission (AUC: 0.781). IEWS consistently outperformed NEWS across all outcomes (p < 0.05, DeLong's test).
conclusionIEWS outperformed NEWS in predicting in-hospital mortality, 30-day mortality, and ICU admission among non-traumatic ED patients. Given its high sensitivity, specificity, and overall discriminative performance, IEWS may serve as a reliable bedside tool for patient risk stratification in the ED. Large-scale multicenter studies are needed to confirm its generalizability across diverse populations. CLINICAL TRIAL NUMBER: Not applicable.
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