Comparison of five early warning scores in predicting mortality risk in patients presenting to the emergency department with acute dyspnea: qSOFA, NEWS2, MEWS, HASI, and SIL

Year 2025, Volume: 11 Issue: 5, 845 - 857, 04.09.2025

Neslihan Ergün Süzer , Süleyman Alpar , Ali Cankut Tatlıparmak , Sarper Yılmaz

https://doi.org/10.18621/eurj.1738116

Abstract

Objectives: This study aimed to compare five early warning scores - Quick Sequential Organ Failure Assessment (qSOFA), National Early Warning Score 2 (NEWS2), Modified Early Warning Score (MEWS), Hospital Alert Severity Index (HASI), and Shock Index-Lactate (SIL) - in predicting 30-day mortality in elderly patients presenting to the emergency department (ED) with acute dyspnea.

Methods: This was a single-center, retrospective observational study. A total of 764 patients aged 65 years or older presenting to the emergency department with acute dyspnea over a five-year period were included in this study. The predictive accuracy of each score was evaluated using AUROC analysis and logistic regression.

Results: Our findings demonstrated that the qSOFA score had the highest accuracy in predicting 30-day mortality (AUROC: 0.768). Among these scores, qSOFA showed the best performance in predicting mortality with a sensitivity of 72.9% and specificity of 74.6%. In logistic regression analysis, the qSOFA score demonstrated the strongest independent association with 30-day mortality (odds ratio [OR]: 5.23, P<0.001). The SIL score also showed a significant association with mortality (OR: 1.29, P=0.035). However, the HASI (P=0.092), MEWS (P=0.726), and NEWS2 (P=0.344) scores were not independently significant in multivariable analysis. Regarding mortality timing, qSOFA was identified as the most robust predictor for early death (within the first 3 days) with an AUROC of 0.801. It also demonstrated superior performance in predicting late in-hospital death (after 3 days) with an AUROC of 0.632 and post-discharge mortality within 30 days with an AUROC of 0.788. Other scores (HASI, MEWS, NEWS2, SIL) demonstrated lower performance in predicting mortality across different time intervals.

Conclusions: qSOFA demonstrated the most consistent and accurate performance among the evaluated scores. It may serve as a practical tool for early risk stratification in elderly patients with acute dyspnea in ED settings.

Keywords

Dyspnea , elderly , emergency department , qSOFA , early warning score

Ethical Statement

This study was approved by the Memorial Şişli Hospital Ethics Committee (Decision No: 2024/004; date: 26.12.2024). All procedures were conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments. The retrospective observational study included patients who presented to the EDs of two tertiary care hospitals: istanbul Beykent University Hospital and Memorial Bahçelievler Hospital. Due to the retrospective design of the study, the institutional review board granted a waiver of informed consent.

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