Article Text

Download PDFPDF
Glucose as an additional parameter to National Early Warning Score (NEWS) in prehospital setting enhances identification of patients at risk of death: an observational cohort study
  1. Hanna Vihonen1,2,
  2. Mitja Lääperi2,
  3. Markku Kuisma2,
  4. Jussi Pirneskoski2,
  5. Jouni Nurmi2
  1. 1 Department of Emergency Medicine and Services, Päijät-Häme Central Hospital, Lahti, Finland
  2. 2 Department of Emergency Medicine and Services, Helsinki University and Helsinki University Hospital, Helsinki, Finland
  1. Correspondence to Dr Hanna Vihonen, Department of Emergency Medicine and Services, Päijät-Häme Central Hospital, Lahti, Finland; hanna.vihonen{at}


Background To determine if prehospital blood glucose could be added to National Early Warning Score (NEWS) for improved identification of risk of short-term mortality.

Methods Retrospective observational study (2008–2015) of adult patients seen by emergency medical services in Helsinki metropolitan area for whom all variables for calculation of NEWS and a blood glucose value were available. Survival of 24 hours and 30 days were determined. The NEWS parameters and glucose were tested by multivariate logistic regression model. Based on ORs we formed NEWSgluc model with hypoglycaemia (≤3.0 mmol/L) 3, normoglycaemia 0 and hyperglycaemia (≥11.1 mmol/L) 1 points. The scores from NEWS and NEWSgluc were compared using discrimination (area under the curve), calibration (Hosmer-Lemeshow test), likelihood ratio tests and reclassification (continuous net reclassification index (cNRI)).

Results Data of 27 141 patients were included in the study. Multivariable regression model for NEWSgluc parameters revealed a strong association with glucose disturbances and 24-hour and 30-day mortality. Likelihood ratios (LRs) for mortality at 24 hours using a cut-off point of 15 were for NEWSgluc: LR+ 17.78 and LR− 0.96 and for NEWS: LR+ 13.50 and LR− 0.92. Results were similar at 30 days. Risks per score point estimation and calibration model showed glucose added benefit to NEWS at 24 hours and at 30 days. Although areas under the curve were similar, reclassification test (cNRI) showed overall improvement of classification of survivors and non-survivors at 24 days and 30 days with NEWSgluc.

Conclusions Including glucose in NEWS in the prehospital setting seems to improve identification of patients at risk of death.

  • emergency ambulance systems, effectiveness
  • acute care
  • clinical assessment, effectiveness
  • metabolic/diabetes/endocrine
  • prehospital care, clinical management

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors HV is responsible for analysing the data and writing the manuscript. MK, ML, JP and JN edited the manuscript. All authors take responsibility of the integrity of the contents. The authors have no conflicts of interest.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by Helsinki University Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.