Prehospital Early Warning Scores to Predict Mortality in Patients Using Ambulances
Authors' conclusion
This study found that EWSs in daily clinical use in emergency medical settings performed moderately in the prehospital field among unselected patients who used ambulances when assessed based on initial measurements of vital signs.
Study context
- Population
- Unselected adults (≥18 years) using ambulances in the North Denmark Region, July 2016–December 2020
- Participants
- 107,569 unique patients
- Comparison
- Prehospital early warning scores based on first vital signs on scene
- Outcome
- 30-day mortality (discrimination by AUROC and AUPRC)
- Follow-up
- 30 days
Methodological detailsvalidation cohort, prehospital, regional
- Validation cohort
- Prehospital
- Regional
Performance
As reported in the abstract
30-day mortality
| Test or model | AUROC | Area under the precision recall curve (AUPRC) |
|---|---|---|
| DEPT | 0.67 (95% CI, 0.66-0.68) | |
| mNEWS | 0.68 (95% CI, 0.68-0.69) | 0.14 (95% CI, 0.13-0.14) |
| qSOFA | 0.59 (95% CI, 0.59-0.60) | 0.09 (95% CI, 0.09-0.09) |
AUROC
DEPT0.67 (95% CI, 0.66-0.68)
mNEWS0.68 (95% CI, 0.68-0.69)
qSOFA0.59 (95% CI, 0.59-0.60)
Area under the precision recall curve (AUPRC)
DEPT— not stated in the abstract
mNEWS0.14 (95% CI, 0.13-0.14)
qSOFA0.09 (95% CI, 0.09-0.09)
- qSOFA vs other scores: P vs other scores < .001 — qSOFA lower performance
Secondary outcomes
| Outcome | Values |
|---|---|
| 1-day mortality | RETTS AUROC 0.72 (95% CI, 0.71-0.73) · DEPT AUROC 0.75 (95% CI, 0.74-0.76) · AUPRC 0.04 (95% CI, 0.04-0.04) · qSOFA AUPRC 0.02 (95% CI, 0.02-0.03) |
| ICU admission | RETTS AUROC 0.66 (95% CI, 0.65-0.67) · mNEWS AUROC 0.68 (95% CI, 0.67-0.69) · qSOFA AUPRC 0.03 (95% CI, 0.03-0.03) · DEPT AUPRC 0.05 (95% CI, 0.04-0.05) |
1-day mortality
- NEWS2, mNEWS, RETTS and DEPT performed similarly; all EWSs had low AUPRCs
Intensive care unit (ICU) admission
- NEWS2, mNEWS, RETTS and DEPT performed similarly; all EWSs had low AUPRCs
Original publication
Prehospital Early Warning Scores to Predict Mortality in Patients Using Ambulances. JAMA Netw Open. Published 1 August 2023. doi:10.
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