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Research Snapshot Theater: Quality and Patient Safety, Adult and Pediatric II

Early Warning Score Performance in Predicting Future Organ Support Needs at the Time of ED Admission

Sunday, March 22, 2026
11:00 AM - 12:00 PM Central Time
Location: Connections Central - RST 10

  • Sam R. Chiacchia, MD

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • YD

    Yaowei Deng, N/A

    PhD Student
    Stanford University, Department of Biomedical Data Science

    Disclosure information not submitted.

  • AG

    Alexandra June Gordon, MD

    Stanford University Medical Center

    Disclosure information not submitted.

  • HH

    Haley Hedlin, PhD

    Senior Biostatistician and Associate Director, Clinical Trials Program
    Stanford University, Quantitative Sciences Unit

    Disclosure information not submitted.

  • Natalie Htet, MD, MS (she/her/hers)

    Stanford University Medical Center
    Stanford University, California

    Disclosure information not submitted.

  • NL

    Nicholas Levin, MD

    Critical Care Physician
    Legacy Health, Portalnd Oregon

    Disclosure information not submitted.

  • AM

    Ankita Mishra, N/A

    Biostatistician
    Stanford University

    Disclosure information not submitted.

  • JW

    Jennifer G. Wilson, MD, MS

    Clinical Associate Professor of Emergency Medicine
    Stanford Universtiy School of Medicine

    Disclosure information not submitted.

Introduction: Early identification and appropriate triage of high risk emergency department (ED) patients at the time of hospital admission is essential, especially as ICU capacity becomes increasingly constrained. Early warning scores (EWS) such as the National Early Warning Score 2 (NEWS2) are widely recommended as risk stratification tools, yet their ability to predict imminent organ support needs at the time of admission from the ED is uncertain. We evaluated the predictive performance of NEWS2 and its derivatives—NEWS2-Lactate (NEWS2-L) and the International Early Warning Score (IEWS)—for forecasting organ support or death within 24 hours of ED admission.


Methods: We conducted a retrospective cohort study of adults admitted from the ED to non-surgical, non-psychiatric services at a U.S. quaternary care hospital (March 2022–February 2024). Patients already receiving organ support in the ED were excluded. EWS were computed using vital signs closest to the admission order. The primary outcome was initiation of vasopressors, mechanical ventilation, new renal replacement therapy (RRT), or death within 24 hours. Predictive performance was assessed using AUROC, sensitivity, and specificity. Secondary analyses assessed EWS performance by individual organ support types, and different score thresholds.


Results: Among 27,971 admitted patients, 83% met inclusion criteria; of these 23,216 patients, 12% required organ support or died during their admission. Most events occurred within 48 hours. Admission NEWS2 showed limited accuracy for predicting organ support or death at 24 hours (AUROC: 0.62). IEWS and NEWS2-L were more sensitive but less specific. NEWS2 better predicted vasopressor use (AUROC: 0.82) and death (0.83) than intubation (0.77) or new RRT (0.50). NEWS2 scores ≥5 missed over 20% of cases; a threshold ≥1.5 was needed to achieve ≥80% sensitivity, encompassing over half the cohort.


Conclusions: While NEWS2 and derivatives modestly predict vasopressor use and mortality at 24 hours, they underperform for intubation, renal replacement, and composite outcomes. More precise tools are needed to support critical care triage decisions at the time of ED disposition.