Efetividade do NEWS 2 na detecção precoce da deterioração clínica de adultos com sepse no Pronto Atendimento: coorte retrospectiva

Abstract

Introduction: Clinical deterioration can be predicted by changes in vital signs. However, its interpretation depends on the observer's experience, which increases the risk of errors. To optimize decision-making based on worsening vital signs, standardized tools such as the National Early Warning Score 2 (NEWS 2) have been developed. Created by the Royal College of Physicians for adult patients, its effectiveness has been evaluated in various hospital settings. Nonetheless, gaps remain regarding its external validity in specific contexts, particularly in diverse settings such as general hospitals in Brazil. Objective: To evaluate the effectiveness of NEWS 2 in the early detection of clinical deterioration in adult patients with sepsis in the emergency department of a general hospital. Method: This was a retrospective cohort observational study. The sample included adult patients admitted with a confirmed diagnosis of sepsis to the emergency department of a private general hospital in Manaus, Amazonas, who met the inclusion criteria and whose clinical decision-making was based on NEWS 2. We analyzed the frequency of positive results (cases where the tool correctly predicted clinical worsening, group yes [GY]) and negative results (cases where NEWS 2 failed to predict clinical worsening, group no [GN]). The characteristics of the sample and patient outcomes were described. Regression analysis was used to adjust for confounders. The Kolmogorov-Smirnov test was applied to assess data distribution. For normally distributed data, the mean and standard deviation (SD) were calculated, and for non-normal distributions, the median and interquartile range (IQR) were computed (difference between Q3 [75%] and Q1 [25%]). Mean comparisons were performed using the Student’s t-test, and median comparisons with the Mann-Whitney test. Categorical variables such as mortality (yes/no) and unplanned ICU transfer (yes/no) were analyzed using the Chi-Square test. Kaplan-Meier survival curves were used to evaluate time to death relative to NEWS 2 scores, and a logistic regression model was applied to identify factors associated with adverse clinical outcomes. Results were presented in tables of absolute and relative frequencies, and statistical analysis was performed using STATA version 14. Results: The sample consisted of 246 patients with a mean age of 63.75 years. Among the patients, 56.1% were women, and 75.2% had comorbidities. The mortality rate in the study was 17.1%, and 83.7% of patients showed clinical improvement after interventions based on NEWS 2. The NEWS 2 score was effective in the early detection of clinical deterioration in adult patients with sepsis in the emergency department. The most compelling evidence of its effectiveness was the strong association between elevated NEWS 2 scores and increased mortality risk. Patients with scores above 7 had a 12-fold higher risk of death compared to those with scores between 3-4 (p < 0.001). Kaplan-Meier curves showed a progressive reduction in survival probability with increasing NEWS 2 scores. The main conditions associated with clinical deterioration included desaturation (34.5%), hypotension (33.6%), and respiratory distress (31.8%). Conclusion: This study confirmed the effectiveness of NEWS 2 as a tool for the early detection of clinical deterioration in patients with sepsis, highlighting its relevance for optimizing hospital resources, supporting clinical decisions, and improving outcomes in general hospital settings