Dr Emma Vardy

Research highlights delirium detection gap

The National Early Warning Score (NEWS2) is insufficient when used alone for detection of delirium in older people

That’s the conclusion of a research study involving nearly 14,000 patients at Salford Royal in the two years from March 2020 to March 2022. It has been published in the Royal College of Physicians’ Clinical Medicine Journal.

The study found the NEWS2 tool is very specific in detection of possible delirium but is insensitive and many cases are missed.

The study’s lead author Professor Emma Vardy has recommended that there could be improved options for recording new confusion in the next update to the NEWS2. These include considering the options available to record when someone is both alert and has new confusion and/or linking NEWS2 completion to the 4AT delirium assessment tool, at least on admission to hospital. A triple assessment using the  NEWS2 alongside the 4AT and the Clinical Frailty Scale, recommended by the Getting It Right First Time (GIRFT) geriatric medicine report, may also be a meaningful way forward for older patients.

Routine observations

Prof Vardy is a Consultant Geriatrician and the frailty lead for Northern Care Alliance, as well as Honorary Clinical chair with the Manchester Academic Health Sciences network and, NIHR CRN GM specialty lead for ageing and deputy lead for the NIHR ARC Greater Manchester Health Ageing theme.

Prof Vardy said: “The National Early Warning Score (NEWS) was introduced in the UK in 2012 and the NEWS2 update in 2017 added ‘new confusion’ including disorientation and/or agitation. It uses routine observations to help clinicians identify acutely unwell patients, so that treatment can be escalated.

“Delirium affects a quarter of hospital admissions of older people and is a serious medical condition with poor outcomes so it is vital that we are able to effectively identify patients who are affected when they are admitted to hospital.”

In a separate review of the NEWS2 tool, published in the same issue of RCP Clinical Medicine Journal, she and colleagues review the evidence for NEWS and NEWS2 in assessment of the older person in different settings, including potential benefits and limitations for care home residents. There should be specific consideration of how the NEWS2 is used in assessment of the older person in future versions.

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