Predictive performance of the National Early Warning Score 2-Brazilian Version for septic patients

Abstract

Objectives: To evaluate the predictive performance of the National Early Warning Score 2 – Brazilian Version, as compared to two other instruments for clinical deterioration, Intensive Care Unit admission, and in-hospital mortality of patients with suspected or confirmed sepsis admitted to an Emergency Service. Methods: Prospective cohort study conducted from October 2021 to February 2022 with 295 adult patients in a public hospital in southern Brazil. Data collection was performed using a specific instrument developed by the researchers, with two assessments at different times: at risk classification in emergency services, and as the patient was transferred to another service for the last time. Predictive performance was assessed using the area under the curve (AUC) of the ROC, sensitivity, and specificity, comparing the scores across the evaluated outcomes and time points. Results: For clinical deterioration, the National Early Warning Score 2-Brazilian Version showed an AUC of 0.703, 95% CI (0.63–0.77), p<0.001, and an AUC of 0.871, 95% CI (0.82–0.91), p<0.001 in the first and second assessments, respectively. For admission to the Intensive Care Unit, all three scores remained accurate only in the second assessment, with the National Early Warning Score 2-Brazilian Version yielding the best results, AUC: 0.830, 95% CI (0.76–0.89), p<0.001 compared to the others. For in-hospital mortality, it presented an AUC of 0.770, 95% CI (0.70–0.83), p<0.001 in the second assessment. Conclusion: National Early Warning Score 2 – Versão Brasileira showed better predictive performance metrics compared to the other scores in the evaluated stages.