Utilizing the National Early Warning Score 2 (NEWS2) to confirm the impact of emergency department management in sepsis patients: a cohort study from taiwan 1998–2020

Utilizing the National Early Warning Score 2 (NEWS2) to confirm the impact of emergency department management in sepsis patients: a cohort study from taiwan 1998–2020

Hospital mortality, National early warning score 2 (NEWS2), Prediction score, Sepsis, Sequential organ
failure assessment score (SOFA score)

Abstract
Background Most sepsis patients could potentially experience advantageous outcomes from targeted medical
intervention, such as fluid resuscitation, antibiotic administration, respiratory support, and nursing care, promptly
upon arrival at the emergency department (ED). Several scoring systems have been devised to predict hospital
outcomes in sepsis patients, including the Sequential Organ Failure Assessment (SOFA) score. In contrast to prior
research, our study introduces the novel approach of utilizing the National Early Warning Score 2 (NEWS2) as a means
of assessing treatment efficacy and disease progression during an ED stay for sepsis.
Objectives To evaluate the sepsis prognosis and effectiveness of treatment administered during ED admission in
reducing overall hospital mortality rates resulting from sepsis, as measured by the NEWS2.
Methods The present investigation was conducted at a medical center from 1997 to 2020. The NEWS2 was
calculated for patients with sepsis who were admitted to the ED in a consecutive manner. The computation was
based on the initial and final parameters that were obtained during their stay in the ED. The alteration in the NEWS2
from the initial to the final measurements was utilized to evaluate the benefit of ED management to the hospital
outcome of sepsis. Univariate and multivariate Cox regression analyses were performed, encompassing all clinically
significant variables, to evaluate the adjusted hazard ratio (HR) for total hospital mortality in sepsis patients with
reduced severity, measured by NEWS2 score difference, with a 95% confidence interval (adjusted HR with 95% CI).
The study employed Kaplan-Meier analysis with a Log-rank test to assess variations in overall hospital mortality rates
between two groups: the “improvement (reduced NEWS2)” and “non-improvement (no change or increased NEWS2)”
groups.
Results The present investigation recruited a cohort of 11,011 individuals who experienced the first occurrence
of sepsis as the primary diagnosis while hospitalized. The mean age of the improvement and non-improvement
groups were 69.57 (±16.19) and 68.82 (±16.63) years, respectively. The mean SOFA score of the improvement and
non-improvement groups were of no remarkable difference, 9.7 (±3.39) and 9.8 (±3.38) years, respectively. The total
hospital mortality for sepsis was 42.92% (4,727/11,011). Following treatment by the prevailing guidelines at that
time, a total of 5,598 out of 11,011 patients (50.88%) demonstrated improvement in the NEWS2, while the remaining
5,403 patients (49.12%) did not. The improvement group had a total hospital mortality rate of 38.51%, while the
non-improvement group had a higher rate of 47.58%. The non-improvement group exhibited a lower prevalence of
comorbidities such as congestive heart failure, cerebral vascular disease, and renal disease. The non-improvement
group exhibited a lower Charlson comorbidity index score [4.73 (±3.34)] compared to the improvement group
[4.82 (±3.38)] The group that underwent improvement exhibited a comparatively lower incidence of septic shock
development in contrast to the non-improvement group (51.13% versus 54.34%, P<0.001). The improvement
group saw a total of 2,150 patients, which represents 38.41% of the overall sample size of 5,598, transition from the
higher-risk to the medium-risk category. A total of 2,741 individuals, representing 48.96% of the sample size of 5,598
patients, exhibited a reduction in severity score only without risk category alteration. Out of the 5,403 patients (the
non-improvement group) included in the study, 78.57% (4,245) demonstrated no alteration in the NEWS2. Conversely,
21.43% (1,158) of patients exhibited an escalation in severity score. The Cox regression analysis demonstrated that
the implementation of interventions aimed at reducing the NEWS2 during a patient’s stay in the ED had a significant
positive impact on the outcome, as evidenced by the adjusted HRs of 0.889 (95% CI=0.808, 0.978) and 0.891 (95%
CI=0.810, 0.981), respectively. The results obtained from the Kaplan-Meier analysis indicated that the survival rate
of the improvement group was significantly higher than that of the non-improvement group (P<0.001) in the
hospitalization period.
Conclusion The present study demonstrated that 50.88% of sepsis patients obtained improvement in ED,
ascertained by means of the NEWS2 scoring system. The practical dynamics of NEWS2 could be utilized to depict
such intricacies clearly. The findings also literally supported the importance of ED management in the comprehensive
course of sepsis treatment in reducing the total hospital mortality rate.
Keywords Hospital mortality, National early warning score 2 (NEWS2), Prediction score, Sepsis, Sequential organ
failure assessment score (SOFA score)

Ming-Shun Hsieh1,2,3,4, Kuan-Chih Chiu5

, Amrita Chattopadhyay5
, Tzu-Pin Lu5

, Shu-Hui Liao6

, Chia-Ming Chang2,3,

Yi-Chen Lee1
, Wei-En Lo1
, Vivian Chia-Rong Hsieh7

, Sung-Yuan Hu4,8,9,3† and Chorng-Kuang How2,3*†

https://doi.org/10.1186/s12245-024-00614-4

2024

Peri Irawan

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