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The following is a summary of “Accuracy of the National Early Warning Score version 2 (NEWS2) in predicting need for time-critical treatment: retrospective observational cohort study,” published in the January 2025 issue of Emergency Medicine by Goodacre et al. 

Researchers conducted a retrospective study to specify the accuracy of the National Early Warning Score version 2 (NEWS2) in predicting the need for time-critical treatment.  

They randomly selected 4,000 adults who attended a tertiary hospital ED in England between 1 January and 31 December 2022, with NEWS2 routinely recorded. The first NEWS2 score, and vital signs were drawn out from electronic records. Research nurses identified cases that received potentially time-critical treatment, and 2 independent clinical experts determined whether such treatment was warranted using an expert consensus-derived list of interventions. Receiver operating characteristic analysis was performed, and sensitivity and specificity were calculated at predefined thresholds to evaluate NEWS2’s accuracy in predicting the need for time-critical treatment and 7-day mortality as a secondary outcome.  

The results showed that after excluding 10 patients, 164/3,990 (4.1%) required time-critical treatment, and 71/3,990 (1.8%) died within 7 days. The NEWS2 predicted the need for time-critical treatment with a c-statistic of 0.807 (95% CI 0.765 to 0.849) and 7-day mortality with a c-statistic of 0.865 (95% CI 0.813 to 0.917). A NEWS2 score >4 predicted time-critical treatment with 51.8% sensitivity (95% CI 44.2%, 59.3%) and 25.8% positive predictive value (95% CI 21.3%, 30.7%). Among the 45 patients needing emergency surgery, antibiotics for open fractures, insulin infusion, or limb-threatening injury manipulation, 37 had NEWS2 ≤4. Patients with NEWS2 >4 who did not require time-critical treatment often had maximum scores for respiratory rate, consciousness level, or supplemental oxygen.  

Investigators concluded the NEWS2 demonstrated limited accuracy in predicting the need for time-critical interventions, with several identified interventions frequently occurring in patients with low NEWS2 scores, highlighting potential areas where NEWS2 may overestimate the need for urgent care. 

Source: emj.bmj.com/content/early/2025/01/11/emermed-2024-214562