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National early warning scores following emergency hospital transfer : implications for care home residents
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Barker, Robert O., Atkin, Catherine, Hanratty, Barbara, Kingston, Andrew, Cooksley, Tim, Gordon, Adam, Holland, Mark, Knight, Thomas, Subbe, Christian and Lasserson, Daniel (2023) National early warning scores following emergency hospital transfer : implications for care home residents. Journal of the American Medical Directors Association, 24 (5). pp. 653-656. doi:10.1016/j.jamda.2023.01.013 ISSN 1525-8610.
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Official URL: https://doi.org/10.1016/j.jamda.2023.01.013
Abstract
Objective
Care home residents have high rates of hospital admission. The UK National Early Warning Score (NEWS2) standardizes the secondary care response to acute illness; however, the ability of NEWS2 to predict adverse health outcomes specifically for care home residents is unknown. This study explored the relationship between NEWS2 on admission to hospital and resident outcome 7 days later.
Design
Repeated cross-sectional study.
Setting and Participants
Data on UK care home residents admitted to 160 hospitals in two 24-hour periods (2019 and 2020).
Method
Chi-squared and Kruskal-Wallis tests, and multinomial regression were used to explore the association between low (score ≤2), intermediate (3–4), high (5–6), and critically high (≥7) NEWS2 on admission and each of the following: discharge on day of admission, admission and discharge within 7 days, prolonged hospital admission (>7 days), and death.
Results
From 665 resident admissions across 160 hospital sites, NEWS2 was low for 54%, intermediate for 18%, high for 13%, and critically high for 16%. The 7-day outcome was 10% same-day discharge, 47% admitted and subsequently discharged, 34% remained inpatients, and 8% died. There is a significant association between NEWS2 and these outcomes (P < .001). Compared with those with low NEWS2, residents with high and critically high NEWS2 had 3.6 and 9.5 times increased risk of prolonged hospitalization (relative risk ratio [RRR] 3.56; 95% CI 1.02–12.37; RRR 9.47; CI 2.20–40.67), respectively. The risk of death was approximately 14 times higher for residents with high NEWS2 (RRR 13.62; CI 3.17–58.49) and 54 times higher (RRR 53.50; CI 11.03–259.54) for critically high NEWS2.
Conclusion and Implications
Higher NEWS2 measurements on admission are associated with an increased risk of hospitalization up to 7 days’ duration, prolonged admission, and mortality for care home residents. NEWS2 may have a role as an adjunct to acute care decision making for hospitalized residents.
Item Type: | Journal Article | ||||||||
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Subjects: | R Medicine > RA Public aspects of medicine R Medicine > RC Internal medicine |
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||||||
Library of Congress Subject Headings (LCSH): | Intensive care units -- Admission and discharge -- Decision making, Critical care medicine, Older people -- Nursing home care, Nursing home care | ||||||||
Journal or Publication Title: | Journal of the American Medical Directors Association | ||||||||
Publisher: | Elsevier | ||||||||
ISSN: | 1525-8610 | ||||||||
Official Date: | May 2023 | ||||||||
Dates: |
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Volume: | 24 | ||||||||
Number: | 5 | ||||||||
Page Range: | pp. 653-656 | ||||||||
DOI: | 10.1016/j.jamda.2023.01.013 | ||||||||
Status: | Peer Reviewed | ||||||||
Publication Status: | Published | ||||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||||
Date of first compliant deposit: | 2 February 2023 | ||||||||
RIOXX Funder/Project Grant: |
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