National Early Warning Score 2 Lactate (NEWS2-L) in Predicting Early Clinical Deterioration in Patients with Dyspnoea in Prehospital Care.
Raúl Villanueva Rábano, Francisco Martín-Rodríguez, Raúl López-Izquierdo
PMID 34822232WHAT IT FOUND
In 638 ambulance patients with breathing difficulty, adding a venous lactate value to NEWS2 predicted death within 48 hours better than NEWS2 alone.
Key findings
01For death within 48 hours, NEWS2-L had the best AUC-ROC among the three scores, at 0.854 with a cut-off of 12.2.
02NEWS2-L exceeded NEWS2 and lactate for death at seven and 30 days, with AUC-ROC values of 0.788 and 0.744.
03At 48 hours, lactate alone had the best sensitivity and specificity, followed by NEWS2-L, with a considerable difference from NEWS2.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study assessed prediction of mortality, not whether using NEWS2-L changed care or mortality. It included only patients whose reason for assistance was dyspnoea, so it does not address other prehospital presentations. The study excluded patients who died during the callout or transfer. The methods state inclusion between 1 April 2018 and 30 June 2019, while the results state inclusion between 1 April 2018 and 30 October 2019. The authors state that many early warning systems exist, making it hard to select between them. The authors state that other prehospital analytical parameters, such as blood gases and electrolytes, could offer more data but were not used. The authors state that only prehospital values were studied, not serial hospital measurements, and that efficacy in other conditions remains to be assessed.
Declared interests
The study was funded by Castilla y León Regional Health Management (SACYL) under project numbers GRS 1678/A/18 and GRS 1903/A/19, with Francisco Martín-Rodríguez as principal investigator. The supplied text does not report competing interests.
The easy way to misread this
Do not conclude that NEWS2-L should replace NEWS2 or lactate in routine practice. The study measured prediction only, and at 48 hours lactate alone had the best sensitivity and specificity.