PREDICTIVE VALUE OF THE NATIONAL EARLY WARNING SCORE 2 (NEWS2) AND THE AUSTRALASIAN TRIAGE SCALE (ATS) FOR IDENTIFYING HIGH-RISK PATIENTS OR THOSE REQUIRING EMERGENCY INTERVENTION IN THE EMERGENCY DEPARTMENT
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Abstract
Objective: To evaluate the predictive value of the National Early Warning Score 2 (NEWS2) and the Australasian Triage Scale (ATS) for adverse clinical outcomes, and to assess the performance of a combined NEWS2–ATS model in identifying high-risk patients presenting to the Emergency Department.
Methods: A retrospective study was conducted using 600 medical records of patients aged 16 years and older who presented to the Emergency Department between January and December 2025. NEWS2 scores and ATS triage categories were retrospectively recorded at the time of initial assessment. The composite study outcome comprised ICU admission, in-hospital mortality, or the need for emergency surgery/procedures.. Predictive performance was evaluated using receiver operating characteristic (ROC) curve analysis and the area under the curve (AUC).
Results: The mean age of the study population was 51.5 ± 20.3 years, and 58.3% were female. Overall, 18.8% of patients experienced adverse clinical outcomes, including 13.5% requiring ICU admission, 10.3% undergoing emergency surgery/intervention, and 2.0% in-hospital mortality. NEWS2 demonstrated good predictive performance for adverse outcomes with an AUC of 0.78 (95% CI: 0.733–0.831), significantly outperforming ATS alone (AUC = 0.67, 95% CI: 0.620–0.715; p = 0.001). The combined NEWS2–ATS model showed a modest improvement in predictive accuracy (AUC = 0.79, 95% CI: 0.744–0.840). Among patients classified as intermediate acuity (ATS categories 3–4), NEWS2 maintained good discriminatory ability (AUC = 0.769). Notably, among patients triaged as ATS categories 3–4, those with NEWS2 ≥5 had a substantially higher incidence of adverse outcomes (69.4%) compared with those with NEWS2 <5 (11.9%). Multivariable logistic regression demonstrated that each one-point increase in NEWS2 was associated with a 1.66-fold increase in the odds of adverse clinical outcomes (p < 0.001). The optimal NEWS2 cutoff for predicting adverse outcomes was ≥5, yielding 82% sensitivity and 65% specificity.
Conclusion: NEWS2 demonstrated good prognostic performance for predicting adverse clinical outcomes in the Emergency Department and outperformed the ATS triage system alone. Integrating NEWS2 into the triage process may improve the identification of high-risk patients, particularly those classified as intermediate acuity, thereby reducing the risk of under-triage and facilitating timely clinical intervention.
Keywords
NEWS2, ATS, Emergency triage, High-risk identification, Emergency Department
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References
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