Incorporation of age into patient early warning scores significantly improves mortality prediction.
QJM · 2024-02-17 · Observational study
Abstract
BACKGROUND: Age is a critical factor for the assessment of patients attended by emergency medical services (EMSs). However, how age modifies early warning scores' (EWSs) predictive ability should be unveiled. AIM: To determine how age influences the performance of EWS [National Early Warning Score 2 (NEWS2), VitalPAC-Early Warning Score (ViEWS), Rapid Acute Physiology Score (RAPS) and modified Rapid Emergency Medicine Score (mREMS)] to predict 2-day mortality. The secondary objective was to determine the performance of EWSs at different age ranges. DESIGN: A prospective, observational study performed between November 2019 and July 2023. METHODS: A multicenter, ambulance-based study, considering 38 basic life support units and six advanced life support units referring to four tertiary care hospitals. Eligible patients were adults recruited from among all phone requests for emergency assistance who were later evacuated to emergency departments. The primary outcome was 2-day in-hospital mortality (includes all-cause mortality). The main measures were demographical and vital signs needed for EWS calculation. RESULTS AND DISCUSSION: A total of 8028 participants fulfilled the inclusion criteria, with 7654 survivors and 374 non-survivors. Among age ranges, the 2-day mortality was 2.8% for the ≤44 years, 3.3% for the 45-64 years, 4.1% for the 65-74 years and 6.7% for the ≥75-year age group. The inclusion of age significantly improved the Area Under the Curve (AUC) in all the scores (P = 0.006 for non-age-adjusted mREMS, P = 0.001 for NEWS2, P = 0.002 for ViEWS, P = 0.028 for RAPS, all compared with their counterparts with age). CONCLUSION: Our results demonstrated that the incorporation of age into the EWS improved the performance of the scores. These results will allow the EMS to improve patient management and resource optimization by including an easy-to-obtain variable.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Early warning scores · Mortality & survival
Related articles
- Can early warning scores identify deteriorating patients in pre-hospital settings? A systematic review. (Resuscitation, 2018)
- Modified Sequential Organ Failure Assessment score for prehospital critical care: defining thresholds and clinical implications. (Eur J Intern Med, 2026)
- Effect of Glycemia and Diabetes on Early Warning Scores Performance in Prehospital Patients With Acute Illness: Multicenter, Prospective, Cohort Study. (Mayo Clin Proc, 2026)
- Development and Internal Validation of a Multivariable Prehospital Prediction Score for Critical Illness Progression and 30-Day Mortality in Non-Traumatic EMS Patients. (J Healthc Leadersh, 2026)
- Association between initial patient acuity and the predictive performance of the MREMS: A nationwide retrospective cohort study. (Am J Emerg Med, 2025)
- Machine learning to improve predictive performance of prehospital early warning scores. (Sci Rep, 2025)