Glucose as a new parameter to National Early Warning Score (NEWS) for better outcome prediction in the Emergency Medical Service (EMS): a retrospective study.
Aim of the study: National early warning score (NEWS) is proved to be the best screening tool for detecting critically ill patients based on vital sings in the hospital surroundings and in the emergency medical service (EMS). As glucose homeostasis disturbance during critical illness is related to poor outcome, we hypothesized that adding blood glucose as an additional parameter to NEWS increases the accuracy of scoring on mortality prediction.
Methods: NEWS was collected retrospectively by utilizing electronic EMS data record system from 2008 to 2015. All adult patients with valid NEWS values and a measured plasma glucose value were included in the study. Plasma glucose was categorized to hyperglycaemia (≥11.1 mmol/l) and severe hypoglycaemia (≤3.0 mmol/l). Survival of the patients was followed from Population Register Centre. Primary outcome was mortality at 24 hours. Association of NEWS score(±glucose disturbance) and mortality was assessed using multivariate logistic regression model .
Results: 27 122 patients were included in the analyses. NEWS predicted morality better in the hypoglycaemic [OR 5.47, (95% CI: 2.88-9.66) or hyperglycaemic (OR 1.54, (95% CI: 1.11-2.12)] patients groups than NEWS score alone without glucose disturbance considered [OR 1.38, (95% CI: 1.33-1.42)]. Considering only patients cases with high NEWS values (≥7 aggregate points) the results did not change markedly.
Conclusions: Blood glucose can increase the accuracy of the NEWS in prehospital setting. We suggest validating blood glucose as a new additional parameter to NEWS.
