Related Info Links
More by Authors Links
Journal Browser
Volume | Year
Issue
News and Announcements
ORIGINAL RESEARCH ARTICLE
Early identification of high-risk septic patients requiring critical care: Diagnostic accuracy of NEWS and qSOFA using hierarchical modeling
Muhammad Abubakar1 ,
Ubaid ur Rehman Khizar2 ,
Wagma Khan3 ,
Muhammad Zeeshan4 ,
Abdullah Ashfaq5 ,
Misbah Shirin Memon6 ,
Maheen Zahid7 ,
Abeer Murad Khamisani8 ,
Muhammad Ahmad7 ,
Ayoola Awosika9*
Show Less
1 Accident and Emergency Department, Integrated Medical Care Hospital, Lahore, Punjab , Pakistan
2 Accident and Emergency Department, Evercare Hospital, Lahore, Punjab , Pakistan
3 Department of Pediatrics, District Headquarters Teaching Hospital, Mardan, Khyber Pakhtunkhwa , Pakistan
4 Department of Internal Medicine, DHQ Hospital, Chiniot, Punjab , Pakistan
5 Department of Trauma and Orthopedics, Kings Mill Hospital, Sutton in Ashfield, Nottinghamshire , United Kingdom
6 Department of General Medicine, Pakistan Institute of Medical Sciences, Islamabad, Islamabad , Pakistan
7 Accident and Emergency Department, King Edward Medical University, Lahore, Punjab , Pakistan
8 Accident and Emergency Department, Liaquat National Hospital and Medical College, Karachi, Sindh , Pakistan
9 Department of Family and Community Medicine, College of Medicine Peoria, University of Illinois, Bloomington, Illinois , United States of America
EJMO, 026250284 https://doi.org/10.36922/EJMO026250284
Received: 17 June 2026 | Revised: 13 August 2026 | Accepted: 31 August 2026 | Published online: 17 September 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
Abstract
Introduction: Early identification of septic patients at risk of deterioration is essential for care escalation and outcomes. This study evaluated the accuracy and utility of the National Early Warning Score (NEWS) and quick Sequential Organ Failure Assessment (qSOFA) for predicting mortality and identifying sepsis patients who may require critical care.
Methods: PubMed, Cochrane Library, and Google Scholar were searched for studies evaluating NEWS and qSOFA in adults with suspected infection or sepsis. Data were extracted to construct 2 × 2 tables. A bivariate random-effects model estimated sensitivity and specificity, and hierarchical summary receiver operating characteristic curves, diagnostic odds ratios (DORs), and post-test probabilities assessed utility.
Results: Ten studies involving 17,762 patients met eligibility criteria; five provided 2 × 2 data for in-hospital mortality synthesis. NEWS and qSOFA were associated with mortality (NEWS: risk ratio [RR] = 2.89, 95% confidence interval [CI]: 1.82–4.59; qSOFA: RR = 2.98, 95% CI: 1.84–4.83). NEWS had higher sensitivity (0.71) but lower specificity (0.56); qSOFA had lower sensitivity (0.44) and higher specificity (0.83). Pooled DORs were comparable (NEWS: 3.83; qSOFA: 3.82), indicating similar performance. At a pre-test probability of 15%, positive NEWS and qSOFA increased mortality to 22% and 31%, while negative results reduced it to 8% and 11%, showing complementary risk profiles.
Conclusion: NEWS and qSOFA show comparable prognostic performance but distinct diagnostic characteristics. NEWS may enable earlier detection of deterioration risk, whereas qSOFA may better identify higher-risk adverse outcomes. A complementary sequential approach may support early stratification, timely intensive care escalation, and sepsis management decisions.
Keywords
Sepsis
Intensive care
Risk stratification
National Early Warning Score
quick Sequential Organ Failure Assessment
Mortality
Funding
None.
Conflict of interest
The authors declare no conflicts of interest.
References
- GBD 2021 Global Sepsis Collaborators. Global, regional, and national sepsis incidence and mortality, 1990-2021: a systematic analysis. Lancet Glob Health. 2025;13(12):e2013-e2026. doi: 10.1016/S2214-109X(25)00356-0
- Machado FR, Cavalcanti AB, Braga MA, et al. Sepsis in Brazilian emergency departments: a prospective multicenter observational study. Intern Emerg Med. 2023;18(2):409-421. doi: 10.1007/s11739-022-03179-3
- Özkaya S, Yurdakul MS. Impact of emergency department-to-intensive care unit transfer time on in-hospital mortality: A retrospective cohort study. Medicine (Baltimore). 2025;104(51):e46724. doi: 10.1097/MD.0000000000046724
- Medeiros RP, Teixeira C. Early ICU mortality: An opportunity for proactive triage, ethical deliberation, and integrated models of care. J Clin Anesth Intensive Care. 2025;5(1):7-9. doi: 10.46439/anesthesia.5.024
- Gerry S, Bonnici T, Birks J, et al. Early warning scores for detecting deterioration in adult hospital patients: systematic review and critical appraisal of methodology. BMJ. 2020;369:m1501. doi: 10.1136/bmj.m1501
- Wanlumkhao W, Rattanamongkolgul D, Ekpanyaskul C. Performance of Early Sepsis Screening Tools for Timely Diagnosis and Antibiotic Stewardship in a Resource-Limited Thai Community Hospital. Antibiotics (Basel). 2025;14(7):708. doi: 10.3390/antibiotics14070708
- Usman OA, Usman AA, Ward MA. Comparison of SIRS, qSOFA, and NEWS for the early identification of sepsis in the Emergency Department. Am J Emerg Med. 2019;37(8):1490-1497. doi: 10.1016/j.ajem.2018.10.058
- Sivayoham N, Hussain AN, Shabbo L, Christie D. An observational cohort study of the performance of the REDS score compared to the SIRS criteria, NEWS2, CURB65, SOFA, MEDS and PIRO scores to risk-stratify emergency department suspected sepsis. Ann Med. 2021;53(1):1863-1874. doi: 10.1080/07853890.2021.1992495
- Lam RPK, Dai Z, Lau EHY, et al. Comparing 11 early warning scores and three shock indices in early sepsis prediction in the emergency department. World J Emerg Med. 2024;15(4):273-282. doi: 10.5847/wjem.j.1920-8642.2024.052
- Guan G, Lee CMY, Begg S, Crombie A, Mnatzaganian G, Kuo YH. The use of early warning system scores in prehospital and emergency department settings to predict clinical deterioration: A systematic review and meta-analysis. PLoS One. 2022;17(3):e0265559. doi: 10.1371/journal.pone.0265559
- Chua WL, Rusli KDB, Aitken LM. Early warning scores for sepsis identification and prediction of in-hospital mortality in adults with sepsis: A systematic review and meta-analysis. J Clin Nurs. 2024;33(6):2005-2018. doi: 10.1111/jocn.17061
- Daorattanachai K, Maithong S, Phungoen P, Weschawalit S, Srivilaithon W. Respiratory National Early Warning Score for 28-day mortality prediction in suspected sepsis patients in the emergency department. BMC Emerg Med. 2025;26(1):17. doi: 10.1186/s12873-025-01443-1
- Brink A, Alsma J, Verdonschot RJCG, et al. Predicting mortality in patients with suspected sepsis at the Emergency Department; A retrospective cohort study comparing qSOFA, SIRS and National Early Warning Score. PLoS One. 2019;14(1):e0211133. doi: 10.1371/journal.pone.0211133
- Goulden R, Hoyle MC, Monis J, et al. qSOFA, SIRS and NEWS for predicting in-hospital mortality and ICU admission in emergency admissions treated as sepsis. Emerg Med J. 2018;35(6):345-349. doi: 10.1136/emermed-2017-207120
- Mohammadi P, Dekker R, Brown V, et al. A prospective, observational study of the performance of MEWS, NEWS, SIRS and qSOFA for early risk stratification for adverse outcomes in patients with suspected infections at the emergency department. Acute Med. 2021;20(2):116-124. doi: 10.52964/amja.0851
- Oduncu AF, Kıyan GS, Yalçınlı S. Comparison of qSOFA, SIRS, and NEWS scoring systems for diagnosis, mortality, and morbidity of sepsis in emergency department. Am J Emerg Med. 2021;48:54-59. doi: 10.1016/j.ajem.2021.04.006
- Suttapanit K, Satiracharoenkul S, Sanguanwit P, Prachanukool T. The Accuracy of Sepsis Screening Score for Mortality Prediction at Emergency Department Triage. West J Emerg Med. 2022;23(5):698-705. doi: 10.5811/westjem.2022.6.56754
- Ruangsomboon O, Boonmee P, Limsuwat C, Chakorn T, Monsomboon A. The utility of the rapid emergency medicine score (REMS) compared with SIRS, qSOFA and NEWS for Predicting in-hospital Mortality among Patients with suspicion of Sepsis in an emergency department. BMC Emerg Med. 2021;21(1):2. doi: 10.1186/s12873-020-00396-x
- Boekhoud L, Schaap HMEA, Huizinga RL, et al. Predictive performance of NEWS and qSOFA in immunocompromised sepsis patients at the emergency department. Infection. 2024;52(5):1863-1873. doi: 10.1007/s15010-024-02247-4
- Devia-Jaramillo GA, Erazo-Guerrero L, Laguado-Castro V, Alfonso-Parada JM. Evaluating Sepsis Mortality Predictions from the Emergency Department: A Retrospective Cohort Study Comparing qSOFA, the National Early Warning Score, and the International Early Warning Score. J Clin Med. 2025;14(14):4869. doi: 10.3390/jcm14144869
- Xythalis D, Kalafati M, Mpouzika M, et al. A Real-Time Prospective Evaluation of the Prognostic Accuracy of SIRS, MEWS, NEWS2 and qSOFA in Predicting ICU Admission and Mortality in an Emergency Department: Implications for Nursing Practice. Nurs Crit Care. 2026;31(1):e70302. doi: 10.1111/nicc.70302
- Marosi V, Gadda G, Timoftica C, Alberti A, Destrebecq A. National Early Warning Score 2 to Identify Sepsis in the Emergency Department. A Review of the Literature. J Med Clin Nurs Stud. 2023:1-5. doi: 10.61440/jmcns.2023.v1.15
- Durr D, Niemi T, Despraz J, et al. National Early Warning Score (NEWS) Outperforms Quick Sepsis-Related Organ Failure (qSOFA) Score for Early Detection of Sepsis in the Emergency Department. Antibiotics (Basel). 2022;11(11):1518. doi: 10.3390/antibiotics11111518
- Wang C, Xu R, Zeng Y, Zhao Y, Hu X. A comparison of qSOFA, SIRS and NEWS in predicting the accuracy of mortality in patients with suspected sepsis: A meta-analysis. PLoS One. 2022;17(4):e0266755. doi: 10.1371/journal.pone.0266755