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National Early Warning Scores Following Emergency Hospital Transfer: Implications for Care Home Residents

Barker, Robert O.; Atkin, Catherine; Hanratty, Barbara; Kingston, Andrew; Cooksley, Tim; Gordon, Adam L.; Holland, Mark; Knight, Thomas; Subbe, Christian P.; Lasserson, Daniel S.

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Robert O. Barker

Catherine Atkin

Barbara Hanratty

Andrew Kingston

Tim Cooksley

Professor of The Care of Older People

Mark Holland

Thomas Knight

Christian P. Subbe

Daniel S. Lasserson


Objective: Care home residents have high rates of hospital admission. The UK National Early Warning Score (NEWS2) standardizes the secondary care response to acute illness. However, the ability of NEWS2 to predict adverse health outcomes specifically for care home residents is unknown. This study explored the relationship between NEWS2 on admission to hospital and resident outcome 7 days later. Design: Repeated cross-sectional study. Setting and Participants: Data on UK care home residents admitted to 160 hospitals in two 24-hour periods (2019 and 2020). Method: Chi-squared and Kruskal-Wallis tests, and multinomial regression were used to explore the association between low (score ≤2), intermediate (3–4), high (5–6), and critically high (≥7) NEWS2 on admission and each of the following: discharge on day of admission, admission and discharge within 7 days, prolonged hospital admission (>7 days), and death. Results: From 665 resident admissions across 160 hospital sites, NEWS2 was low for 54%, intermediate for 18%, high for 13%, and critically high for 16%. The 7-day outcome was 10% same-day discharge, 47% admitted and subsequently discharged, 34% remained inpatients, and 8% died. There is a significant association between NEWS2 and these outcomes (P < .001). Compared with those with low NEWS2, residents with high and critically high NEWS2 had 3.6 and 9.5 times increased risk of prolonged hospitalization [relative risk ratio (RRR) 3.56; 95% CI 1.02–12.37; RRR 9.47; CI 2.20–40.67], respectively. The risk of death was approximately 14 times higher for residents with high NEWS2 (RRR 13.62; CI 3.17–58.49) and 54 times higher (RRR 53.50; CI 11.03–259.54) for critically high NEWS2. Conclusion and Implications: Higher NEWS2 measurements on admission are associated with an increased risk of hospitalization up to 7 days duration, prolonged admission, and mortality for care home residents. NEWS2 may have a role as an adjunct to acute care decision making for hospitalized residents.

Journal Article Type Article
Acceptance Date Jan 18, 2023
Online Publication Date Feb 20, 2023
Publication Date 2023-05
Deposit Date Feb 1, 2023
Publicly Available Date Feb 21, 2024
Journal Journal of the American Medical Directors Association
Print ISSN 1525-8610
Electronic ISSN 1538-9375
Publisher Elsevier BV
Peer Reviewed Peer Reviewed
Volume 24
Issue 5
Pages 653-656
Keywords Acute care; care home residents; early warning scores; health outcomes
Public URL
Publisher URL
Additional Information This article is maintained by: Elsevier; Article Title: National Early Warning Scores Following Emergency Hospital Transfer: Implications for Care Home Residents; Journal Title: Journal of the American Medical Directors Association; CrossRef DOI link to publisher maintained version:; Content Type: article; Copyright: © 2023 Published by Elsevier Inc. on behalf of AMDA -- The Society for Post-Acute and Long-Term Care Medicine.


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