Clinical medicine (London, England)
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This year is the 10th anniversary since the launch of the National Early Warning Score (NEWS) by the Royal College of Physicians in 2012. This review reflects on the journey, from the nascent concept of a standardised system to detect acute illness severity and clinical deterioration through to the adoption of NEWS2 by the NHS and, ultimately, its incorporation into quality indicators of acute care provision. The impact of NEWS/NEWS2 on the transformation of provision and configuration and training of acute care teams in hospitals is reviewed. ⋯ The ultimate aim of NEWS was to improve patient outcomes with acute illness or deterioration and the impact on outcomes is now becoming apparent but, paradoxically, an effective response can eliminate the link between the score and the ultimate outcome. This review concludes with a reflection on what the next 10 years may bring, particularly with the digital transformation of healthcare and its potential impact on scoring systems, as well as the necessary permeation of NEWS2 beyond the acute hospital setting into emergency response triage in primary and community care settings. Ten years on, via NEWS/NEWS2, the NHS is the first healthcare system globally with a 'common language' of illness severity and a standardised early warning system for acute clinical illness and deterioration, a system that is now being replicated in many other areas of the world.
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A 61-year-old man with hypertension and psoriasis, which was treated with adalimumab, was admitted after a 1-month history of fever following a dental implantation. Computed tomography of the chest revealed a pseudoaneurysm in the aortic arch, and blood culture grew Salmonella enterica A diagnosis of mycotic pseudoaneurysm of the aortic arch due to Salmonella was made, and he was treated with cefoperazone-sulbactam. During his hospital stay, he developed hoarseness followed by haemoptysis, and underwent thoracic endovascular aortic repair followed by emergency open surgical repair. However, he died 5 weeks after the surgery due to acute upper gastrointestinal bleeding, which was confirmed as an aortoesophageal fistula by oesophagogastroscopy.
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The National Early Warning Score 2 (NEWS2) is the established track and trigger system to assess illness severity and risk of deterioration for patients in acute episodes of care in the UK. It is also increasingly used internationally. In this article, we outline established and recommended practice for initial and ongoing assessment. We also highlight where practice may not meet these standards, how the full context and assessment of the patient is paramount, and opportunities for more accurate assessment in the future.
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Cerebral amyloid angiopathy (CAA) is a common cause of lobar cerebral haemorrhage in elderly populations, which can present as transient focal neurological episodes (TFNEs) or sometimes known as 'amyloid spells'. CAA-TFNE poses a common diagnostic challenge to physicians as it can be difficult to distinguish from transient ischaemic attacks or other transient neurologic syndromes. Prompt recognition of CAA is crucial as it heralds a high risk of intracerebral haemorrhage and to avoid unnecessary investigation with inappropriate long-term prevention treatment.
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As more healthcare is provided in non-hospital settings, it is essential to support clinicians in recognising early signs of clinical deterioration to enable prompt intervention and treatment. There are intuitive reasons why the use of the National Early Warning Score 2 (NEWS2) in out-of-hospital settings may enhance the community response to acute illness by using a common language across healthcare. An additional advantage of the use of NEWS2 in community settings is that it is not disease specific and requires no expensive technology or great expertise to take a full set of observations that can be an indicator of clinical acuity. However, concerns have been expressed as NEWS2 was developed in acute hospital settings that it may not be applicable in community settings; this review shares some of the practical ways that NEWS2 can support clinical practice along with the emerging published evidence.