AI Article Synopsis
- The study assessed how incorporating a weighted variable for the fraction of inspired oxygen (FiO) into the National Early Warning Score 2 (NEWS2) could enhance its ability to predict patient deterioration.
- The analysis of 3,704 adult patients with viral respiratory infections showed that the modified score, called NEWS-FiO, provided a stronger correlation with adverse outcomes like cardiac arrest and unplanned critical care admissions.
- The results indicated a significant improvement in predictive performance (AUROC of 0.81 for NEWS-FiO compared to 0.77 for traditional NEWS2), particularly for those on supplemental oxygen, with an increase in positive predictive value without greatly compromising sensitivity.
Article Abstract
Objectives: The National Early Warning Score 2 (NEWS2) is validated for predicting acute deterioration, however, the binary grading of inspired oxygen fraction (FiO) may limit performance. We evaluated the incorporation of FiO as a weighted categorical variable on NEWS2 prediction of patient deterioration.
Setting: Two hospitals at a single medical centre, Guy's and St Thomas' NHS Foundation Trust.
Design: Retrospective cohort of all ward admissions, with a viral respiratory infection (SARS-CoV-2/influenza).
Participants: 3704 adult ward admissions were analysed between 01 January 2017 and 31 December 2021.
Methods: The NEWS-FiO score transformed FiO into a weighted categorical variable, from 0 to 3 points, substituting the original 0/2 points. The primary outcome was a composite of cardiac arrest, unplanned critical care admission or death within 24 hours of the observation. Sensitivity, positive predictive value (PPV), number needed to evaluate (NNE) and area under the receiver operating characteristic curve (AUROC) were calculated. Failure analysis for the time from trigger to outcome was compared by log-rank test.
Results: The mean age was 60.4±19.4 years, 52.6% were men, with a median Charlson Comorbidity of 0 (IQR 3). The primary outcome occurred in 493 (13.3%) patients, and the weighted FiO score was strongly associated with the outcome (p=<0.001). In patients receiving supplemental oxygen, 78.5% of scores were reclassified correctly and the AUROC was 0.81 (95% CI 0.81 to 0.81) for NEWS-FiO versus 0.77 (95% CI 0.77 to 0.77) for NEWS2. This improvement persisted in the whole cohort with a significantly higher failure rate for NEWS-FiO2 (p=<0.001). At the 5-point threshold, the PPV increased by 22.0% (NNE 6.7) for only a 3.9% decrease in sensitivity.
Conclusion: Transforming FiO into a weighted categorical variable improved NEWS2 prediction for patient deterioration, significantly improving the PPV. Prospective external validation is required before institutional implementation.
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Source |
|---|---|
| http://dx.doi.org/10.1136/bmjresp-2023-001657 | DOI Listing |
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10749069 | PMC |
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