Efetividade do National Early Warning Score (News 2) na deteção precoce da deterioração clínica de pacientes hospitalizados: revisão sistemática com metanálise

Abstract

Introduction: Early detection of clinical deterioration in hospitalized patients is essential to reduce complications and mortality. The National Early Warning Score (NEWS 2) is widely used for hospital triage, but the literature lacks a comprehensive synthesis of its effectiveness and prognostic accuracy in different populations. Objective: To evaluate the effectiveness of NEWS 2 in the early detection of clinical deterioration and its accuracy in predicting adverse events, comparing it with other prognostic scales. Method: We conducted a systematic review with meta-analysis following the PRISMA 2020 guidelines. We searched PubMed, Web of Science (WOS), Embase, LILACS, Google Scholar, and gray literature to identify studies published between 2017 and 2024 in English and Portuguese. We considered eligible observational studies and clinical trials that evaluated the effectiveness of NEWS 2 in the early detection of clinical deterioration in hospitalized adult patients, using the outcomes predicting adverse events (death, need for ICU, and mechanical ventilation). We excluded case reports, narrative reviews, and studies with insufficient data for extraction. We assessed the risk of bias using the Joanna Briggs Institute tool and heterogeneity using Higgins and Thompson's I². We used the random-effects model for meta-analysis, considering confidence intervals (95% CI) for sensitivity and specificity estimates, and to compare the relative efficacy of the different prognostic scales, we used the P-score. Results: We included 10 studies totaling 339,216 patients. High heterogeneity was observed for ICU admission (I² = 79.88%) and mortality due to adverse events (I² = 75.2%), and moderate heterogeneity for in-hospital mortality (I² = 45.2%).. NEWS 2 presented pooled sensitivity: 88% (95% CI: 85%-91%), pooled specificity: 75% (95% CI: 70%-80%), area under the ROC curve (AUC): 0.85 (95% CI: 0.82-0.88), ICU admission rate: 20% (95% CI: 9.0%- 30.7%), in-hospital mortality rate: 9.2% (95% CI: 4.3%-14.1%). The results showed that scales such as SMART-COP and CRB-65 presented the highest P-scores, demonstrating better performance in outcomes such as the need for invasive ventilation and in-hospital mortality. Next came the NEWS 2 and PSI scales, which demonstrated intermediate performance. Scales such as MEWS and qSOFA presented the lowest P-scores, reflecting lower predictive accuracy in the clinical contexts analyzed. Conclusion: The findings confirmed the high sensitivity of NEWS 2, especially for critical conditions such as sepsis and acute respiratory diseases, which reduces hospital mortality and improves initial management. However, specificity was lower than other scales, which may generate false alarms and unnecessary interventions. The AUC ROC curve analysis showed a reasonable performance of NEWS 2 in predicting mortality, need for ventilation, and prolonged hospitalization, but lower than specialized scales such as TRIAGE and DECAF. Despite the limitations, NEWS 2 remains a valuable tool, especially when combined with other scales. Research Limitations: Heterogeneity between populations and clinical settings may have influenced the meta-analysis results.