@article{TEXTUAL,
      recid = {11159},
      author = {Liu, Vincent X. and Lu, Yun and Carey, Kyle A. and  Gilbert, Emily R. and Afshar, Majid and Akel, Mary and  Shah, Nirav S. and Dolan, John and Winslow, Christopher and  Kipnis, Patricia and Edelson, Dana P. and Escobar, Gabriel  J. and Churpek, Matthew M.},
      title = {Comparison of Early Warning Scoring Systems for  Hospitalized Patients with and Without Infection at Risk  for In-Hospital Mortality and Transfer to the Intensive  Care Unit},
      journal = {JAMA Network Open},
      address = {2020-05-19},
      number = {TEXTUAL},
      abstract = {&lt;p&gt;Importance: Risk scores used in early warning systems  exist for general inpatients and patients with suspected  infection outside the intensive care unit (ICU), but their  relative performance is incompletely characterized.  &lt;/p&gt;&lt;p&gt;Objective: To compare the performance of tools used  to determine points-based risk scores among all  hospitalized patients, including those with and without  suspected infection, for identifying those at risk for  death and/or ICU transfer.&lt;/p&gt;&lt;p&gt;Design, Setting, and  Participants: In a cohort design, a retrospective analysis  of prospectively collected data was conducted in 21  California and 7 Illinois hospitals between 2006 and 2018  among adult inpatients outside the ICU using points-based  scores from 5 commonly used tools: National Early Warning  Score (NEWS), Modified Early Warning Score (MEWS), Between  the Flags (BTF), Quick Sequential Sepsis-Related Organ  Failure Assessment (qSOFA), and Systemic Inflammatory  Response Syndrome (SIRS). Data analysis was conducted from  February 2019 to January 2020.&lt;/p&gt;&lt;p&gt;Main Outcomes and  Measures: Risk model discrimination was assessed in each  state for predicting in-hospital mortality and the combined  outcome of ICU transfer or mortality with area under the  receiver operating characteristic curves (AUCs). Stratified  analyses were also conducted based on suspected  infection.&lt;/p&gt;&lt;p&gt;Results: The study included 773477  hospitalized patients in California (mean [SD] age, 65.1  [17.6] years; 416 605 women [53.9%]) and 713786  hospitalized patients in Illinois (mean [SD] age, 61.3  [19.9] years; 384 830 women [53.9%]). The NEWS exhibited  the highest discrimination for mortality (AUC, 0.87; 95%  CI, 0.87-0.87 in California vs AUC, 0.86; 95% CI, 0.85-0.86  in Illinois), followed by the MEWS (AUC, 0.83; 95% CI,  0.83-0.84 in California vs AUC, 0.84; 95% CI, 0.84-0.85 in  Illinois), qSOFA (AUC, 0.78; 95% CI, 0.78-0.79 in  California vs AUC, 0.78; 95% CI, 0.77-0.78 in Illinois),  SIRS (AUC, 0.76; 95% CI, 0.76-0.76 in California vs AUC,  0.76; 95% CI, 0.75-0.76 in Illinois), and BTF (AUC, 0.73;  95% CI, 0.73-0.73 in California vs AUC, 0.74; 95% CI,  0.73-0.74 in Illinois). At specific decision thresholds,  the NEWS outperformed the SIRS and qSOFA at all 28  hospitals either by reducing the percentage of at-risk  patients who need to be screened by 5% to 20% or increasing  the percentage of adverse outcomes identified by 3% to  25%.&lt;/p&gt;&lt;p&gt;Conclusions and Relevance: In all hospitalized  patients evaluated in this study, including those meeting  criteria for suspected infection, the NEWS appeared to  display the highest discrimination. Our results suggest  that, among commonly used points-based scoring systems,  determining the NEWS for inpatient risk stratification  could identify patients with and without infection at high  risk of mortality.&lt;/p&gt;},
      url = {http://knowledge.uchicago.edu/record/11159},
}