Early detection of risk for clinical deterioration in emergency department patients: validation of a version of the National Early Warning Score 2 for use in Spain

Objective. To determine the ability of a Spanish translation of the National Early Warning Score 2 (NEWS2) to predict hospitalizations and adverse events during triage in hospital emergency departments. Methods. Prospective observational study in 2 phases. Phase 1 took place in October and November 2019 and phase 2 in January and February 2020. Phase 1 involved the translation and back translation process to produce an adapted Spanish version of the NEWS2 tool, the piloting of the adapted tool, and training sessions for nurses on how to use the scale. Phase 2 was a validation study of the translated scale for use in Spain. We analyzed its psychometric properties and capacity to predict adverse events and hospital admissions. Adult patients (over the age of 18 years) were recruited consecutively in a hospital emergency department in Spain. Results. We evaluated 523 patients, 81 in phase 1 and 442 in phase 2. The validated Spanish language version of the NEWS2 tool achieved a Cronbach a score of 0.70. The intraclass correlation coefficients for intra- and inter-observer reliability, respectively, were 0.996 (95% CI, 0.995-0.997) and approaching 1 (95% CI, 0.999-1). The area under the receiver operating characteristic curve was 0.969 (95% CI, 0.938-1) for adverse events and 0.881 (95% CI, 0.8190.943) for hospitalization. Conclusion. The ability of the Spanish version of the NEWS2 scale to predict hospital admissions and adverse events is high when used during hospital emergency department triage.