TY - JOUR
T1 - NEWS2 shows low sensitivity and high specificity for delirium detection
T2 - a single site observational study of 13,908 patients
AU - Vardy, Emma R.L.C.
AU - Santhirasekaran, Schanhave
AU - Cheng, Michael
AU - Anand, Atul
AU - MacLullich, Alasdair M.
N1 - Publisher Copyright:
© 2022 Royal College of Physicians. All rights reserved.
PY - 2022/11/25
Y1 - 2022/11/25
N2 - Delirium affects 25% of hospital admissions of older people and is a serious medical condition with poor outcomes. ‘New confusion’ as a delirium indicator was incorporated into the ‘alert, verbal, pain and unresponsive’ (AVPU) level of consciousness scale in the National Early Warning Score 2 (NEWS2) in 2017. We measured sensitivity of non-alert NEWS2 (new confusion and/or V, P or U ratings) for delirium through comparison with the four ‘A’s test (4AT) delirium tool in 13,908 consecutive non-elective hospital admissions. We included NEWS2 scores 4 hours before or after 4AT. There were 2,802 (20%) admissions with positive 4AT and 594 (4.3%) with non-alert NEWS2 status. Sensitivity of NEWS2 for 4AT ≥4 was 17.8% (95% confidence interval (CI) 16.4–19.2), and specificity was 99.1% (95% CI 98.9–99.3). These findings suggest that NEWS2 in current practice has low sensitivity but high specificity for delirium. Further research is needed to improve routine inpatient monitoring for delirium.
AB - Delirium affects 25% of hospital admissions of older people and is a serious medical condition with poor outcomes. ‘New confusion’ as a delirium indicator was incorporated into the ‘alert, verbal, pain and unresponsive’ (AVPU) level of consciousness scale in the National Early Warning Score 2 (NEWS2) in 2017. We measured sensitivity of non-alert NEWS2 (new confusion and/or V, P or U ratings) for delirium through comparison with the four ‘A’s test (4AT) delirium tool in 13,908 consecutive non-elective hospital admissions. We included NEWS2 scores 4 hours before or after 4AT. There were 2,802 (20%) admissions with positive 4AT and 594 (4.3%) with non-alert NEWS2 status. Sensitivity of NEWS2 for 4AT ≥4 was 17.8% (95% confidence interval (CI) 16.4–19.2), and specificity was 99.1% (95% CI 98.9–99.3). These findings suggest that NEWS2 in current practice has low sensitivity but high specificity for delirium. Further research is needed to improve routine inpatient monitoring for delirium.
KW - 4AT
KW - alertness
KW - delirium
KW - detection
KW - NEWS2
UR - http://www.scopus.com/inward/record.url?scp=85142940547&partnerID=8YFLogxK
U2 - 10.7861/clinmed.2022-0345
DO - 10.7861/clinmed.2022-0345
M3 - Article
C2 - 36427880
AN - SCOPUS:85142940547
SN - 1470-2118
VL - 22
SP - 544
EP - 548
JO - Clinical Medicine, Journal of the Royal College of Physicians of London
JF - Clinical Medicine, Journal of the Royal College of Physicians of London
IS - 6
ER -