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A validation of the National Early Warning Score (NEWS) to predict outcome in patients with COPD exacerbation

A validation of the National Early Warning Score (NEWS) to predict outcome in patients with COPD exacerbation
A validation of the National Early Warning Score (NEWS) to predict outcome in patients with COPD exacerbation
Background: The National Early Warning Score (NEWS), proposed as a standardised track and trigger system, may perform less well in acute COPD exacerbation (AECOPD). This study externally validated NEWS and modifications (CREWS and Salford-NEWS) in AECOPD.

Methods: An observational cohort study (2012-2014, two UK acute medical units [AMUs]), compared AECOPD (2,361 admissions, 942 individuals, ICD-10 J40-44 codes) with AMU patients (37,109 admissions, 20,415 individuals). Outcome: in-hospital mortality prediction by admission NEWS, CREWS and Salford-NEWS assessed by discrimination (area under receiver operating characteristic curves [AUCs]) and calibration (plots and Hosmer-Lemeshow [H-L] goodness-of-fit).

Results: Median admission NEWS in AECOPD was 4 (IQR 2-6) vs 1 (0-3) for AMU (p=<0.001), despite mortality 4.5% in both. AECOPD AUCs were: NEWS 0.74 (95% confidence intervals 0.66 to 0.82), CREWS 0.72 (0.63 to 0.80) and Salford-NEWS 0.62 (0.53 to 0.70). AMU NEWS AUC was 0.77 (0.75 to 0.78). At threshold NEWS=5 for AECOPD (44% of admissions), positive predictive value (PPV) of death was 8% (5 to 11) and negative predictive value (NPV) 98% (97 to 99) vs AMU patients PPV 17% (16 to 19) and NPV 97% (97 to 97). For NEWS in AECOPD H-L P-value =0.202.

Conclusions: This first validation of the NEWS in AECOPD found modest discrimination to predict mortality. Lower specificity of NEWS in AECOPD patients vs other AMU patients reflects acute and chronic respiratory physiological disturbance (including hypoxia), with resultant low PPV at NEWS=5. CREWS and Salford-NEWS, adjusting for chronic hypoxia, increased specificity and PPV but there was no gain in discrimination.
0040-6376
1-9
Hodgson, Luke E.
f1159289-e374-4f11-b923-5781094b6de1
Dimitrov, Borislav D.
366d715f-ffd9-45a1-8415-65de5488472f
Congleton, Jo
2de95859-1912-4294-b909-7f32e7162f34
Venn, Richard
adc24ece-fb8d-4c1e-969b-026ca62db4ec
Forni, Lui G.
e9ca402c-ea28-4d1a-8c4f-7fbaf205bad8
Roderick, Paul J.
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Hodgson, Luke E.
f1159289-e374-4f11-b923-5781094b6de1
Dimitrov, Borislav D.
366d715f-ffd9-45a1-8415-65de5488472f
Congleton, Jo
2de95859-1912-4294-b909-7f32e7162f34
Venn, Richard
adc24ece-fb8d-4c1e-969b-026ca62db4ec
Forni, Lui G.
e9ca402c-ea28-4d1a-8c4f-7fbaf205bad8
Roderick, Paul J.
dbb3cd11-4c51-4844-982b-0eb30ad5085a

Hodgson, Luke E., Dimitrov, Borislav D., Congleton, Jo, Venn, Richard, Forni, Lui G. and Roderick, Paul J. (2016) A validation of the National Early Warning Score (NEWS) to predict outcome in patients with COPD exacerbation. Thorax, 1-9. (doi:10.1136/thoraxjnl-2016-208436). (PMID:27553223)

Record type: Article

Abstract

Background: The National Early Warning Score (NEWS), proposed as a standardised track and trigger system, may perform less well in acute COPD exacerbation (AECOPD). This study externally validated NEWS and modifications (CREWS and Salford-NEWS) in AECOPD.

Methods: An observational cohort study (2012-2014, two UK acute medical units [AMUs]), compared AECOPD (2,361 admissions, 942 individuals, ICD-10 J40-44 codes) with AMU patients (37,109 admissions, 20,415 individuals). Outcome: in-hospital mortality prediction by admission NEWS, CREWS and Salford-NEWS assessed by discrimination (area under receiver operating characteristic curves [AUCs]) and calibration (plots and Hosmer-Lemeshow [H-L] goodness-of-fit).

Results: Median admission NEWS in AECOPD was 4 (IQR 2-6) vs 1 (0-3) for AMU (p=<0.001), despite mortality 4.5% in both. AECOPD AUCs were: NEWS 0.74 (95% confidence intervals 0.66 to 0.82), CREWS 0.72 (0.63 to 0.80) and Salford-NEWS 0.62 (0.53 to 0.70). AMU NEWS AUC was 0.77 (0.75 to 0.78). At threshold NEWS=5 for AECOPD (44% of admissions), positive predictive value (PPV) of death was 8% (5 to 11) and negative predictive value (NPV) 98% (97 to 99) vs AMU patients PPV 17% (16 to 19) and NPV 97% (97 to 97). For NEWS in AECOPD H-L P-value =0.202.

Conclusions: This first validation of the NEWS in AECOPD found modest discrimination to predict mortality. Lower specificity of NEWS in AECOPD patients vs other AMU patients reflects acute and chronic respiratory physiological disturbance (including hypoxia), with resultant low PPV at NEWS=5. CREWS and Salford-NEWS, adjusting for chronic hypoxia, increased specificity and PPV but there was no gain in discrimination.

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More information

Accepted/In Press date: 18 July 2016
e-pub ahead of print date: 23 August 2016
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 401641
URI: https://eprints.soton.ac.uk/id/eprint/401641
ISSN: 0040-6376
PURE UUID: 3fbbd6f2-2c94-4ac1-be58-e278243e86b8
ORCID for Paul J. Roderick: ORCID iD orcid.org/0000-0001-9475-6850

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Date deposited: 14 Nov 2016 12:21
Last modified: 19 Nov 2019 01:58

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