Background: Rapid response teams (RRTs) respond to hospitalized patients experiencing clinical deterioration and\nhelp determine subsequent management and disposition. We sought to evaluate and compare the prognostic\naccuracy of the Hamilton Early Warning Score (HEWS) and the National Early Warning Score 2 (NEWS2) for prediction of\nin-hospital mortality following RRT activation. We secondarily evaluated a subgroup of patients with suspected\ninfection.\nMethods: We retrospectively analyzed prospectively collected data (2012-2016) of consecutive RRT patients from two\nhospitals. The primary outcome was in-hospital mortality. We calculated the number needed to examine (NNE), which\nindicates the number of patients that need to be evaluated in order to detect one future death.\nResults: Five thousand four hundred ninety-one patients were included, of whom 1837 (33.5%) died in-hospital. Mean\nage was 67.4 years, and 51.6% were male. A HEWS above the low-risk threshold (less than equal to 5) had a sensitivity of 75.9% (95%\nconfidence interval (CI) 73.9-77.9) and specificity of 67.6% (95% CI 66.1-69.1) for mortality, with a NNE of 1.84. A NEWS2\nabove the low-risk threshold (less than equal to 5) had a sensitivity of 84.5% (95% CI 82.8-86.2), and specificity of 49.0% (95% CI: 47.4-\n50.7), with a NNE of 2.20. The area under the receiver operating characteristic curve (AUROC) was 0.76 (95% CI 0.75-0.\n77) for HEWS and 0.72 (95% CI: 0.71-0.74) for NEWS2. Among suspected infection patients (n = 1708), AUROC for HEWS\nwas 0.79 (95% CI 0.76-0.81) and for NEWS2, 0.75 (95% CI 0.73-0.78).\nConclusions: The HEWS has comparable clinical accuracy to NEWS2 for prediction of in-hospital mortality among RRT\npatients.
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