Comparison of national early warning score-2 and qSOFA in predicting the prognosis of older adults with altered mental status.

BACKGROUND: Altered mental status occurs in one in four older adults, and the risk increases with age. Numerous scoring systems have been improved to predict mortality, but data are limited for these scoring systems to interpret older adult patients. AIM: We aimed to compare qSOFA and National Early Warning Score-2 (NEWS2) scores in predicting the prognosis of older adults with altered mental status. METHOD: We included 500 older adults with altered mental status. We noted the qSOFA and NEWS2 scores of the patients. We compared the qSOFA and NEWS2 scores for the prediction of 30-day mortality, 48-h mortality, hospitalization clinic, outcome, and hospitalization length. RESULTS: The mean NEWS2 score was 6.4, and the mean qSOFA score was 1.3. For 30-day mortality, the sensitivity and specificity of the NEWS2 score ≥ 5 were 68.29% and 69.6%, respectively, and those of qSOFA score > 1 were 47.14% and 78.75%, respectively. AUC values for 30-day mortality prediction were 0,725 (CI: 0.683-0.763) and 0.631 (CI: 0.587-0.673). For intensive care unit hospitalization prediction, the sensitivity and specificity of the NEWS2 score ≥ 5 were 52.73% and 77.67%, respectively, and those of qSOFA score > 1 were 35.32% and 81.55%, respectively. In patients with a NEWS2 score > 10 points, the predicted 48-h mortality had a specificity of 80.6%, which was higher than the qSOFA score. CONCLUSION: NEWS2 score can be used to predict 48-h mortality, 30-day mortality, and intensive care unit hospitalization compared with qSOFA in older adults with altered mental status.

Revised Trauma Score and CRAMS better predicted mortality in high-energy-trauma patients than Early-Warning Score.

BACKGROUND: Trauma is one of the common reasons for emergency department (ED) presentations. Specifically, severe-trauma patients often present with mortal complications, including traumatic shock or respiratory or multiorgan failure/dysfunction, and these situations cause high-mortality risk. Scoring systems in the triage of trauma patients can help determine the injury's severity and the patient's prognosis. AIM: In this study, we aimed to compare Early-Warning Score (EWS), Revised Trauma Score (RTS), and CRAMS to predict the severity and prognosis of damage among high-energy-trauma patients. METHODS: This retrospective study included adult high-energy-trauma patients (> 18 years of age) assessed in our emergency department (ED) from April 1, 2020, to September 31, 2020. We included a total of 177 high-energy-trauma patients in the study. We compared the effectiveness of EWS; RTS; and circulation, respiration, abdomen, motor, and speech (CRAMS) in predicting mortality. The primary outcome of this study was mortality. RESULTS: We included 67 females and 110 males with a mean age of 39.2 in our study. Of those patients, 6 died during ICU hospitalization and 104 were discharged from the ward. RTS (AUC: 0.978, CI: 0.945-0.994, p < 0.001) and CRAMS (AUC: 0.978, CI: 0.944-0.994, p < 0.001) had the same AUC values, but the AUC value of EWS (AUC: 0.966, CI: 0.927-0.987, p < 0.001) was lower. Sensitivity of EWS was 93.1 (CI: 77.2-99.2%), and sensitivity of RTS was 96.55 (CI: 82.2-99.9) and CRAMS' sensivity was 96.55% (CI: 82.2-99.9). RTS showed the highest specivity level (96.62%, CI: 92.3-98.9). CONCLUSION: In conclusion, RTS and CRAMS better predicted mortality in high-energy-trauma patients than EWS.