Use of news scoring to predict clinical status of COPD patients presenting to emergency service with dyspneal complaints

Introduction and Objective: NEWS (National Early Warning Score) is a scoring system that can be used to evaluate patients clinical progression, hospitalization in services or intensive care units, duration of hospital stay, and most importantly, mortalities based on assessments at the time of and after admission to emergency services. In this study, it was aimed to investigate the use of the NEWS score in predicting the mean life span of patients presenting with acute exacerbation of COPD to the emergency service. Materials and Methods: Patients with COPD aged 18 and over who were admitted to the Medical Faculty Emergency Medicine Department of Inonu University between January 1, 2016 and December 31, 2016 and complained of dyspnea were recruited for our study. During this one-year period, patients eligible for the study were identified from the electronic data system (enlil*), using the International Statistical Classification of Diseases and Related Healt Problems (ICD-10) code system. Categorical variables were compared using Chi-square tests or Fisher's exact tests based on whether they were normally distributed. Numerical variables were compared using unpaired t tests or Mann-Whitney U tests based on whether they were normally distributed. p values below 0.05 were considered statistically significant. Results: The mean age of the patients was 68±11. 82% of them were male and 18% were female. 67% of the patients in this study had a comorbid disease. The comorbid diseases of the patients who were admitted to the study were coronary artery disease (27%), hypertension (19%), heart failure (14%), diabetes mellitus (14%) and pulmonary malignancy (7%). Patients with mortality showed low GCS scores, and high Charlson Comorbidity and NEWS scores (p<0.0001, p=0.004 and p<0.0001, respectively). ROC analyses showed that the cut off value of the Charlson Comorbidity Score was >4 while that of the NEWS score was >7. Patients with a NEWS score >7 were found to have a mean survival of 9.9 months whereas patients with NEWS <7 had 16.6 months. Low mean arterial pressure, low oxygen saturation, low pH, low hemoglobin, high INR, high blood urea nitrogen, high creatinine, high CRP and high carbon dioxide levels were found to be associated with mortality based on the vital signs and laboratory data of the patients. Moreover, FEV 1 and FVC values of the patients with mortality were found to be low. Mortality was higher in the patients with an mMRC dyspnea scale of 4 and in the GOLD stage B and D groups. Patients with severe dyspnea and those in the GOLD stage B and D group were more likely to be hospitalized. Mortality was observed to be higher in patients with pneumonia induced COPD. Conclusion: The NEWS score of the patients presenting with a COPD attack to the emergency service should be calculated for each patient at the time of admission in order to determine the clinical status of the patients, to predict the mortality and to be able to make the decision of hospitalization. Keywords: Emergency service, COPD exacerbation, NEWS score, mortality