In-hospital mortality of 121,262 emergency patients according to their National Early Warning Score, alertness and eight physiologic categories on admission to hospital

Mark Holland; John Kellett; Gareth Hughes; Darren Green

doi:10.52964/AMJA.1002

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In-hospital mortality of 121,262 emergency patients according to their National Early Warning Score, alertness and eight physiologic categories on admission to hospital

Journal article

Peer reviewed

In-hospital mortality of 121,262 emergency patients according to their National Early Warning Score, alertness and eight physiologic categories on admission to hospital

Mark Holland, John Kellett, Gareth Hughes and Darren Green

Acute Medicine Journal, Vol.24(1), pp.9-16

11/10/2025

DOI: https://doi.org/10.52964/AMJA.1002

PMID: 41104565

Abstract

National Early Warning Score

Physiological categories

ROX index

Mortality

Altered Consciousness

Aim: To determine the in-hospital mortality of eight physiological categories based on shock index, pulse pressure and ROX index, and to compare each category according to admission level of consciousness and National Early Warning Score. Method: A non-interventional observational study of 122,262, unselected, adult emergency admissions between 2014 and 2022. Results: In-hospital mortality increases according to physiological category and whether the admission NEWS was<3 or ≥3. For NEWS ≥3, patients were more likely to die when not alert. Irrespective of total NEWS, patients with a low ROX index <22 are more likely to die. Conclusion: Patients with the same NEWS value can have different physiological derangements. Level of consciousness also provides greater insight than NEWS alone regarding the risk of in-patient mortality.

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Title: In-hospital mortality of 121,262 emergency patients according to their National Early Warning Score, alertness and eight physiologic categories on admission to hospital
Creators - without role: Mark Holland - University of Greater Manchester, Advanced Clinical Practice
John Kellett - University of Greater Manchester
Gareth Hughes - University of Greater Manchester, Advanced Clinical Practice
Darren Green - Salford Royal Hospital
Publication Details: Acute Medicine Journal, Vol.24(1), pp.9-16
Publisher: RILA
Identifiers: 9956152008841; 1747-4892
Academic Unit: Advanced Clinical Practice
Language: English
Resource Type: Journal article
Electronic publication date: 11/10/2025
Date accepted: 30/08/2025

In-hospital mortality of 121,262 emergency patients according to their National Early Warning Score, alertness and eight physiologic categories on admission to hospital

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