{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T02:06:01Z","timestamp":1784167561818,"version":"3.55.0"},"reference-count":44,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T00:00:00Z","timestamp":1767830400000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing in Critical Care"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Early identification of emergency department (ED) patients with suspected infection who are at risk for adverse outcomes is a core nursing responsibility during triage and early observation. Scoring systems vary in sensitivity and specificity, with limited prospective, real\u2010time comparisons in Greek EDs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To compare the prognostic accuracy of SIRS, MEWS, NEWS2 and qSOFA for predicting prolonged ICU stay (\u2265\u20093\u2009days) and 28\u2010day in\u2010hospital mortality and to assess performance across clinically relevant subgroups that shape nursing decision\u2010making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Prospective observational study in the ED of a public general hospital in Athens, Greece. Consecutive adults (\u2265\u200918\u2009years) with suspected infection were enrolled. Scores were calculated in real time at triage by trained ED nurses using only presentation data. Primary outcomes were ICU stay \u2265\u20093\u2009days and 28\u2010day in\u2010hospital mortality. Discrimination was assessed by AUROC (95% CI) with DeLong pairwise comparisons; prespecified subgroups included age (\u2265\u200965\u2009years), comorbidities, and COPD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Five hundred and thirty patients who met the inclusion criteria were analysed (mean age 63.7\u2009\u00b1\u200918.5\u2009years; 53.96% female). For predicting ICU \u2265\u20093\u2009days, NEWS2 demonstrated the highest sensitivity, NPV and AUROC (0.72) with no significant differences compared to MEWS or qSOFA, but better than SIRS (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001). For 28\u2010day in\u2010hospital mortality, qSOFA and NEWS2 achieved the highest AUROC (0.79 and 0.77, respectively), both significantly outperforming SIRS and MEWS. NEWS2 maintained the highest sensitivity and NPV, whereas qSOFA showed the highest specificity and PPV. In subgroup analyses, comorbid patients exhibited elevated risk even with negative NEWS2\/MEWS; qSOFA\u2010positive younger patients (&lt;\u200965) had higher ICU admission; COPD was associated with higher mortality in qSOFA\u2010negative and MEWS\u2010negative strata.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>NEWS2 and qSOFA outperformed SIRS and MEWS. NEWS2 is well suited for ruling out risk (very high sensitivity\/NPV), whereas qSOFA provides more specific identification of high\u2010risk patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance to Clinical Practice<\/jats:title>\n                    <jats:p>NEWS2 can help nurses quickly rule out high\u2010risk infection cases, whereas qSOFA highlights patients most likely to need urgent escalation or ICU care. Using both scores together supports faster triage decisions and better allocation of monitoring and critical care resources.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nicc.70302","type":"journal-article","created":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T13:39:26Z","timestamp":1767879566000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Real\u2010Time Prospective Evaluation of the Prognostic Accuracy of\n                    <scp>SIRS<\/scp>\n                    ,\n                    <scp>MEWS<\/scp>\n                    ,\n                    <scp>NEWS2<\/scp>\n                    and\n                    <scp>qSOFA<\/scp>\n                    in Predicting\n                    <scp>ICU<\/scp>\n                    Admission and Mortality in an Emergency Department: Implications for Nursing Practice"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-2003-282X","authenticated-orcid":false,"given":"Dimitrios","family":"Xythalis","sequence":"first","affiliation":[{"name":"Department of Nursing University of Peloponnese  Tripoli Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Kalafati","sequence":"additional","affiliation":[{"name":"Department of Nursing National and Kapodistrian University of Athens  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meropi","family":"Mpouzika","sequence":"additional","affiliation":[{"name":"Department of Nursing, School of Health Sciences Cyprus University of Technology  Limassol Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vassiliki","family":"Karra","sequence":"additional","affiliation":[{"name":"Sismanoglio General Hospital of Attica  Maroussi Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasileios","family":"Kaldis","sequence":"additional","affiliation":[{"name":"Sismanoglio General Hospital of Attica  Maroussi Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Tsekouras","sequence":"additional","affiliation":[{"name":"Sismanoglio General Hospital of Attica  Maroussi Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aikaterini","family":"Sofianou","sequence":"additional","affiliation":[{"name":"Sismanoglio General Hospital of Attica  Maroussi Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandros","family":"Mihopoulos","sequence":"additional","affiliation":[{"name":"Department of Nursing University of Peloponnese  Tripoli Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasios","family":"Ioannidis","sequence":"additional","affiliation":[{"name":"Department of Medicine National and Kapodistrian University of Athens  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Styliani","family":"Tziaferi","sequence":"additional","affiliation":[{"name":"Department of Nursing University of Peloponnese  Tripoli Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,8]]},"reference":[{"key":"e_1_2_16_2_1","doi-asserted-by":"publisher","DOI":"10.4046\/trd.2018.0041"},{"key":"e_1_2_16_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2021.02.006"},{"key":"e_1_2_16_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/19375867221137097"},{"key":"e_1_2_16_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/JHQ.0000000000000129"},{"key":"e_1_2_16_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11739\u2010021\u201002735\u20107"},{"key":"e_1_2_16_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13049\u2010017\u20100449\u2010y"},{"key":"e_1_2_16_8_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201604-0854OC"},{"key":"e_1_2_16_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/84.5.663"},{"key":"e_1_2_16_10_1","doi-asserted-by":"publisher","DOI":"10.1308\/003588406X130615"},{"key":"e_1_2_16_11_1","volume-title":"National Early Warning Score (NEWS) 2: Standardising the Assessment of Acute\u2010Illness Severity in the NHS","author":"Royal College of Physicians","year":"2017"},{"key":"e_1_2_16_12_1","unstructured":"NICE 20 National Institute for Health and Care Excellence \u201cNational Early Warning Score Systems That Alert to Deteriorating Adult Patients in Hospital \u201dNICE 2020."},{"key":"e_1_2_16_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.0287"},{"key":"e_1_2_16_14_1","first-page":"1","article-title":"qSOFA Does Not Replace SIRS in the Definition of Sepsis","volume":"20","author":"Vincent J. L.","year":"2017","journal-title":"Critical Care"},{"key":"e_1_2_16_15_1","doi-asserted-by":"publisher","DOI":"10.2147\/OAEM.S280279"},{"key":"e_1_2_16_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102020\u2010046009"},{"key":"e_1_2_16_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2021.10.046"},{"key":"e_1_2_16_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2018.10.058"},{"key":"e_1_2_16_19_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0211133"},{"key":"e_1_2_16_20_1","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/1802707"},{"key":"e_1_2_16_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/emermed\u20102020\u2010210416"},{"key":"e_1_2_16_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-021-06506-y"},{"key":"e_1_2_16_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2023.110032"},{"key":"e_1_2_16_24_1","unstructured":"R.Daller \u201cModified Early Warning Score in Detecting Clinical Deterioration: A Continuous Quality Improvement Initiative \u201d(2023) Doctor of Nursing Practice (DNP) Manuscripts 45."},{"key":"e_1_2_16_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2014.07.014"},{"key":"e_1_2_16_26_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.101.6.1644"},{"key":"e_1_2_16_27_1","doi-asserted-by":"publisher","DOI":"10.7860\/JCDR\/2016\/18129.8744"},{"key":"e_1_2_16_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.acra.2012.09.012"},{"key":"e_1_2_16_29_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12879\u2010022\u201007070\u20106"},{"key":"e_1_2_16_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjtee.2023.09.001"},{"key":"e_1_2_16_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/s15010-024-02181-5"},{"key":"e_1_2_16_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2017.05.022"},{"key":"e_1_2_16_33_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12245\u2010021\u201000388\u2010z"},{"key":"e_1_2_16_34_1","volume-title":"International Statistical Classification of Diseases and Related Health Problems, 10th Revision","author":"World Health Organization","year":"2016"},{"key":"e_1_2_16_35_1","volume-title":"Point Prevalence Survey of Healthcare Associated Infections and Antimicrobial Use in European Acute Care Hospitals","author":"European Centre for Disease Prevention and Control","year":"2024"},{"key":"e_1_2_16_36_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.0288"},{"key":"e_1_2_16_37_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.20329"},{"key":"e_1_2_16_38_1","doi-asserted-by":"publisher","DOI":"10.4103\/ijciis.ijciis_41_22"},{"key":"e_1_2_16_39_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2021.704358"},{"key":"e_1_2_16_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aucc.2023.01.001"},{"key":"e_1_2_16_41_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.6229"},{"key":"e_1_2_16_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2021.101184"},{"key":"e_1_2_16_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2020.02.022"},{"key":"e_1_2_16_44_1","doi-asserted-by":"publisher","DOI":"10.7861\/clinmedicine.18\u20105\u2010371"},{"key":"e_1_2_16_45_1","doi-asserted-by":"publisher","DOI":"10.7861\/clinmedicine.19\u20101\u201094"}],"container-title":["Nursing in Critical Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nicc.70302","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/nicc.70302","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nicc.70302","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T01:49:02Z","timestamp":1784166542000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/nicc.70302"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":44,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1111\/nicc.70302"],"URL":"https:\/\/doi.org\/10.1111\/nicc.70302","archive":["Portico"],"relation":{},"ISSN":["1362-1017","1478-5153"],"issn-type":[{"value":"1362-1017","type":"print"},{"value":"1478-5153","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-10-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70302"}}