Abstract
Objectives
Early warning scores (EWS) aim to rapidly identify patients at risk of critical illness or life-threatening events before deterioration occurs in clinical settings. This study aimed to compare the ability of three commonly used EWS (National Early Warning Score [NEWS], Surgical Early Warning Score [SEWS], Modified Early Warning Score [MEWS]) to identify gastric cancer patients with deteriorating condition after gastrectomy in general wards.
Methods
This retrospective case-control study included 123 patients who experienced clinical deterioration after gastrectomy for gastric cancer as case group, and 748 patients without deterioration as control group from a tertiary hospital in Guangdong Province, China. The discriminating ability (receiver operating characteristic curves), calibration (goodness-of-fit test) and net benefit (clinical decision curves) of the three EWS (NEWS, SEWS, MEWS) were explored to compare their early warning performance for patients at risk of post-operative deterioration.
Results
MEWS had better calibration (goodness-of-fit p = 0.881 > 0.05) but poorer discrimination (AUC 0.6335, 95%CI 0.5889–0.6781) and limited ability to distinguish patients with poor prognosis after gastrectomy as well as low clinical applicability. NEWS showed better discrimination (AUC 0.8196, 95%CI 0.7746–0.8646) but poorer calibration (goodness-of-fit p = 0.025 < 0.05) and was not recommended. SEWS had good calibration (goodness-of-fit p = 0.353 > 0.05) and discrimination (AUC 0.7085, 95%CI 0.6613–0.7557) with more net benefit and clinical utility compared to MEWS.
Conclusion
Overall, SEWS may be more suitable for identifying gastric cancer patients at risk of post-operative clinical deterioration, as the early warning scoring model with best performance currently for post-gastrectomy observation.