Aplicabilidade da National Early Warning Score 2 para identificação da deterioração clínica e predição de alerta precoce em pacientes clínicos: uma coorte

Abstract

Introduction: Early recognition of signs of clinical deterioration in hospitalized patients and the actions of the Rapid Response Team are important for the prognosis of hospitalized patients. Delays in identifying clinical deterioration increase hospital mortality. Objective: To analyze the applicability of the National Early Warning Score 2 scale for early identification and prediction of the risk of clinical deterioration in hospitalized patients. Method: Prospective cohort study that analyzed clinical outcomes in 213 adult patients hospitalized for more than 24 hours in the medical clinic unit of a large public hospital. Descriptive and inferential analysis was performed, with sensitivity and specificity measurement of NEWS2 by the ROC curve. The ideal cut-off point was determined based on the highest sensitivity and lowest specificity. A p<0.05 was considered significant in all analyses. Results: The majority (50.7%) of the sample patients were women with a mean age of 61 years (±16.26), coming from external transfers, especially from emergency care units (84.66%). There was a predominance of clinical conditions such as systemic arterial hypertension (53.99%), diabetes mellitus (27.23%), cardiovascular diseases (22.07%), neurological diseases (19.25%), and oncological diseases (18.31%). The most frequently verified NEWS2 scores were 5 (22.53%), 7 (16.90%), 4 (15.96%), and 6 (14.55%). It is noteworthy that 34.74% of the patients had a score ≥7, indicating clinical deterioration. The score ≥7 was associated with the presence of chronic lung disease (p=0.016). Regarding the outcome, the majority (81.69%) were discharged from the hospital, while 9.39% were transferred to the intensive care unit and 8.92% died. The Rapid Response Team was called for 8.45% of the patients. NEWS2 accuracy in triggering the Rapid Response Team was 66% (AUC-ROC of 0.66; 95% CI 0.543 – 0.787) (p = 0.021). The NEWS2 cut-off point between 5 and 6 showed the best sensitivity and specificity, being considered in this population the early warning index for triggering the Rapid Response Team. Among adverse events, most (96.15%) were considered mild. Conclusion: The applicability of NEWS2 allowed early identification of the risk of clinical deterioration among patients admitted to medical clinic units and more effective clinical monitoring, reduction of serious complications, transfers to the ICU, and consequently may impact the reduction of hospital costs, survival rate, and promotion of patient safety.