Introduction The National Early Warning Score-2 (NEWS-2) is used to detect deteriorating patients in hospital settings. We aimed to understand how NEWS-2 functions in the real-life setting of an acute respiratory unit. Methods Clinical observations data were extracted for adult patients (age ≥18 years), admitted under the care of respiratory medicine services from July to December 2019, who had at least one recorded task relating to clinical deterioration. The timing and nature of urgent out-of-hours medical reviews (escalations) were extracted through manual review of the case notes. Results The data set comprised 765 admission episodes (48.9% women) with a mean (SD) age of 69.3 (14.8). 8971 out of 35 991 out-of-hours observation sets (24.9%) had a NEWS-2 ≥5, and 586 of these (6.5%) led to an escalation. Out of 687 escalations, 101 (14.7%) were associated with observation sets with NEWS-2<5. Rising oxygen requirement and extreme values of individual observations were associated with an increased risk of escalation. 57.6% of escalations resulted in a change in treatment. Inpatient mortality was higher in patients who were escalated at least once, compared with those who were not escalated. Conclusions Most observation sets with NEWS-2 scores ≥5 did not lead to a medical escalation in an acute respiratory setting out-of-hours, but more than half of escalations resulted in a change in treatment. Rising oxygen requirement is a key indicator of respiratory patient acuity which appears to influence the decision to request urgent out-of-hours medical reviews. No data are available. Current ethical and institutional approvals do not allow data sharing. Proposals for research collaboration involving data sharing should be made to the corresponding author, and will be subject to an ethics amendment and data sharing agreement.

中文翻译：

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国家早期预警评分 2 在急性呼吸科的实际实施

简介 国家早期预警评分 2 (NEWS-2) 用于检测医院环境中病情恶化的患者。我们的目的是了解 NEWS-2 在急性呼吸系统的现实环境中如何发挥作用。方法 提取2019年7月至12月在呼吸内科服务下收治的成年患者（年龄≥18岁）的临床观察数据，这些患者至少有一项与临床恶化相关的记录任务。紧急非工作时间医疗审查（升级）的时间和性质是通过手动审查病例记录来提取的。结果 数据集包含 765 次入院事件（48.9% 为女性），平均 (SD) 年龄为 69.3 (14.8)。在 35 991 个非工作时间观察集中，有 8971 个 (24.9%) 的 NEWS-2 ≥ 5，其中 586 个 (6.5%) 导致升级。在 687 次升级中，101 次 (14.7%) 与 NEWS-2<5 的观察集相关。需氧量的增加和个体观察的极端值与升级风险的增加有关。57.6% 的升级导致治疗方法发生变化。与未升级的患者相比，至少升级过一次的患者的住院死亡率更高。结论 大多数 NEWS-2 评分≥5 的观察集不会导致非工作时间急性呼吸道疾病的医疗升级，但超过一半的升级导致治疗方法的改变。需氧量的增加是呼吸系统患者病情严重程度的一个关键指标，这似乎会影响请求紧急非工作时间医疗检查的决定。无可用数据。目前的道德和机构批准不允许数据共享。涉及数据共享的研究合作提案应向通讯作者提出，并须遵守伦理修正案和数据共享协议。