Gareth Hughes

Advanced Clinical Practice, School of Clinical and Biomedical Sciences, Faculty of Health and Wellbeing, University of Greater Manchester

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

by Mark Holland, John Kellett, Gareth Hughes and Darren Green

First online publication 11/10/2025

Acute Medicine Journal, 24, 1, 9 - 16

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.

Gareth Hughes

Advanced Clinical Practice, School of Clinical and Biomedical Sciences, Faculty of Health and Wellbeing, University of Greater Manchester

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