NEWS2 shows low sensitivity and high specificity for delirium detection: a single site observational study of 13,908 patients

Emma R.L.C. Vardy, Schanhave Santhirasekaran, Michael Cheng, Atul Anand, Alasdair M. MacLullich

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

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.

Original languageEnglish
Pages (from-to)544-548
Number of pages5
JournalClinical Medicine, Journal of the Royal College of Physicians of London
Volume22
Issue number6
DOIs
Publication statusPublished - 25 Nov 2022

Keywords / Materials (for Non-textual outputs)

  • 4AT
  • alertness
  • delirium
  • detection
  • NEWS2

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