Comparison of early warning scores in patients with COPD exacerbation: DECAF and NEWS score

Thorax
Carlos EchevarriaStephen Bourke

Abstract

The National Early Warning Score 2 (NEWS2) includes two oxygen saturation scales; the second adjusts target saturations to 88%-92% for those with hypercapnic respiratory failure. Using this second scale in all patients with COPD exacerbation ('NEWS2All COPD') would simplify practice, but the impact on alert frequency and prognostic performance is unknown. Admission NEWS2 score has not been compared with DECAF (dyspnoea, eosinopenia, consolidation, acidaemia, atrial fibrillation) for inpatient mortality prediction. NEWS, NEWS2 and NEWS2All COPD and DECAF were calculated at admission in 2645 patients with COPD exacerbation attending consecutively to one of six UK hospitals, all of whom met spirometry criteria for COPD. Alert frequency and appropriateness were assessed for all NEWS iterations. Prognostic performance was compared using the area under the receiver operating characteristic (AUROC) curve. Missing data were imputed using multiple imputation. Compared with NEWS, NEWS2 reclassified 3.1% patients as not requiring review by a senior clinician (score≥5). NEWS2All COPD reduced alerts by 12.6%, or 16.1% if scoring for injudicious use of oxygen was exempted. Mortality was low in reclassified patients, with no patients dying th...Continue Reading

References

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Citations

Sep 12, 2019·Thorax·Eui-Sik Suh, Beth Sage
Dec 18, 2019·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine·Joonas TirkkonenMarkus B Skrifvars
Feb 1, 2021·Cardiac Electrophysiology Clinics·Roddy Hiram, Steeve Provencher
Mar 15, 2020·Heart & Lung : the Journal of Critical Care·Francisco Martín-RodríguezMiguel A Castro-Villamor

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Methods Mentioned

BETA
X-ray

Clinical Trials Mentioned

ISRCTN13946813
ISRCTN29082260

Software Mentioned

NEWS
DECAF
SPSS Statistics
NEWS2
SigmaPlot

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