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Volume 62
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10.3390/medicina62020311
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Article

Combining the National Early Warning Score 2 with Frailty Assessment to Identify Patients at Risk of In-Hospital Cardiac Arrest: A Descriptive Exploratory Study

by
Cesare Biuzzi
1,†,
Elena Modica
1,†,
Alessandra Vozza
1,
Roberto Gargiuli
1,
Benedetta Galgani
1,
Giovanni Coratti
1,
Daniele Marianello
2,
Fabio Silvio Taccone
3,
Federico Franchi
2 and
Sabino Scolletta
1,*
1
Urgency-Emergency Anesthesia and Intensive Care Unit, Department of Medical Science, Surgery and Neurosciences, University Hospital of Siena, 53100 Siena, Italy
2
Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, Department of Medical Science, Surgery and Neurosciences, University Hospital of Siena, 53100 Siena, Italy
3
Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Medicina 2026, 62(2), 311; https://doi.org/10.3390/medicina62020311
Submission received: 6 January 2026 / Revised: 27 January 2026 / Accepted: 30 January 2026 / Published: 2 February 2026
(This article belongs to the Section Intensive Care/ Anesthesiology)
Versions Notes

Abstract

Background and objectives: In older and frail patients, in-hospital cardiac arrest (IHCA) is associated with high mortality. Early warning scores such as the National Early Warning Score 2 (NEWS2) are widely used to detect clinical deterioration, but their predictive accuracy in frail populations remains uncertain. This study aimed to assess whether integrating frailty measures with NEWS2 could better describe elderly IHCA patients. Materials and Methods: We conducted a single-center, retrospective observational study in adult and frail patients (≥18 years) admitted to medical and surgical wards of the University Hospital of Siena who experienced IHCA between January 2022 and January 2024. Data on demographics, such as last NEWS2 before IHCA, Clinical Frailty Scale (CFS), Barthel Index (BI), and Charlson Comorbidity Index (CCI) were retrospectively collected and analyzed. Patients were stratified into three categories, according to NEWS2: Stable (A), Potentially Unstable or Unstable (B), and Critical (C). Results: Seventy patients were analyzed (mean age 76.9 ± 11.0 years; 56% male). The mean pre-IHCA NEWS2 score was 6.0 ± 3.5, with 41% of patients classified as NEWS2-C, 48% classified as NEWS2-B, and 11% classified as NEWS2-A. The NEWS2-A category showed higher BI and lower CFS than NEWS2-B and NEWS2-C (p < 0.01), while CCI and age did not significantly differ. Conclusions: The association of NEWS2 with frailty scores could identify some elderly patients with limited pre-arrest physiological derangements but high frailty who suffered from IHCA. These findings provide descriptive insights that may inform monitoring strategies for “at-risk” elderly patients to help prevent IHCA.
Keywords: in-hospital cardiac arrest (IHCA); NEWS2; Clinical Frailty Scale (CFS); Charlson Comorbidity Index (CCI); Barthel Index (BI); Early Warning Systems (EWS); Rapid Response System (RRS) in-hospital cardiac arrest (IHCA); NEWS2; Clinical Frailty Scale (CFS); Charlson Comorbidity Index (CCI); Barthel Index (BI); Early Warning Systems (EWS); Rapid Response System (RRS)

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MDPI and ACS Style

Biuzzi, C.; Modica, E.; Vozza, A.; Gargiuli, R.; Galgani, B.; Coratti, G.; Marianello, D.; Taccone, F.S.; Franchi, F.; Scolletta, S. Combining the National Early Warning Score 2 with Frailty Assessment to Identify Patients at Risk of In-Hospital Cardiac Arrest: A Descriptive Exploratory Study. Medicina 2026, 62, 311. https://doi.org/10.3390/medicina62020311

AMA Style

Biuzzi C, Modica E, Vozza A, Gargiuli R, Galgani B, Coratti G, Marianello D, Taccone FS, Franchi F, Scolletta S. Combining the National Early Warning Score 2 with Frailty Assessment to Identify Patients at Risk of In-Hospital Cardiac Arrest: A Descriptive Exploratory Study. Medicina. 2026; 62(2):311. https://doi.org/10.3390/medicina62020311

Chicago/Turabian Style

Biuzzi, Cesare, Elena Modica, Alessandra Vozza, Roberto Gargiuli, Benedetta Galgani, Giovanni Coratti, Daniele Marianello, Fabio Silvio Taccone, Federico Franchi, and Sabino Scolletta. 2026. "Combining the National Early Warning Score 2 with Frailty Assessment to Identify Patients at Risk of In-Hospital Cardiac Arrest: A Descriptive Exploratory Study" Medicina 62, no. 2: 311. https://doi.org/10.3390/medicina62020311

APA Style

Biuzzi, C., Modica, E., Vozza, A., Gargiuli, R., Galgani, B., Coratti, G., Marianello, D., Taccone, F. S., Franchi, F., & Scolletta, S. (2026). Combining the National Early Warning Score 2 with Frailty Assessment to Identify Patients at Risk of In-Hospital Cardiac Arrest: A Descriptive Exploratory Study. Medicina, 62(2), 311. https://doi.org/10.3390/medicina62020311

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