Perioperative medicine & outcomes
Development and External Validation of the International Early Warning Score for Improved Age- and Sex-Adjusted In-Hospital Mortality Prediction in the Emergency Department
Authors' conclusion
The IEWS substantially improves in-hospital mortality prediction for all ED patients greater than or equal to18 years.
Study context
- Population
- Consecutive emergency department (ED) patients ≥18 years with at least two registered vital signs; development in three Dutch EDs (NEED), external validation in two Danish EDs (Danish Multicenter Cohort (DMC))NEED 95,553
- Comparison
- International Early Warning Score (IEWS) vs National Early warning Score (NEWS)
- Outcome
- In-hospital mortality prediction (discrimination, calibration, reclassification, decision curve analysis)
- Follow-up
- At arrival to the ED
Methodological detailsinternational, multicentre
- International
- Multicentre
Performance
As reported in the abstract
In-hospital mortality prediction, AUC
| Test or model | AUC (NEED) | AUC (DMC, external validation) |
|---|---|---|
| IEWS | 0.89 (95% CI 0.89-0.90) | 0.87 (0.85-0.88) |
| NEWS | 0.82 (95% CI 0.82-0.83) | 0.82 (0.80-0.84) |
AUC (NEED)
IEWS0.89 (95% CI 0.89-0.90)
NEWS0.82 (95% CI 0.82-0.83)
AUC (DMC, external validation)
IEWS0.87 (0.85-0.88)
NEWS0.82 (0.80-0.84)
Further findings
In-hospital mortality rate
- NEED
- 2.4% (n = 2,314)
- DMC
- 2.5% (n = 365)
Calibration, reclassification and net benefit
- IEWS standardized net benefit in the relevant risk range, all age categories
- 5-15%
- NEWS underestimated risk in older patients and overestimated risk in the youngest; calibration improved for IEWS
- Substantial reclassification from low to high risk with IEWS
Original publication
Development and External Validation of the International Early Warning Score for Improved Age- and Sex-Adjusted In-Hospital Mortality Prediction in the Emergency Department. Crit Care Med. Published 23 March 2023. doi:10.
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