Journal of Emergency Practice and Trauma

Evaluation and comparison of diagnostic accuracy of early warning scores in the diagnosis of traumatic brain injury: a prospective study

Document Type : Original Article

Authors

Mohammad Ganji 1
Elham Navab 2
shima haghani 3
mahboobeh shali 2

1 1 Department of Emergency Care Nursing, Tehran School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Critical Care Nursing, Tehran School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

3 Nursing and Midwifery Care Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran

https://doi.org/10.34172/jept.2025.12
Abstract
Objective: When dealing with patients with possible traumatic brain injury, prehospital emergency
personnel must make decisions quickly with very little data. Determining the amount of risk that
threatens patients can lead to making correct treatment decisions. The present study aimed to
determine and compare the diagnostic accuracy of early warning scores in prehospital care for the
diagnosis of traumatic brain injury.
Methods: This prospective study was conducted from December 2023 to January 2025 at hospitals
affiliated with Tehran University of Medical Sciences. Sampling was performed purposefully, and
non-randomly and 250 trauma patients were enrolled in the study. Data collection was carried out
utilizing a demographic questionnaire and various scoring systems, including the National Early
Warning Score (NEWS2), Modified Early Warning Score (MEWS), Triage Early Warning Score (TEWS),
and Modified Emergency Medical Score (MEMS). The data were analyzed using SPSS software.
Results: The mean age of the patients was 40.90±15.78. Accident (56.8%) was the most common
mechanism of trauma, and multiple trauma (56%) was the most common type of trauma. The
National Early Warning Score 2 showed the highest diagnostic accuracy with sensitivity of 82.2%,
specificity of 81.1%, and area under the curve of 0.889(. The results of the independent t-test
showed that the mean score of the NEWS2 in prehospital care for patients with an initial diagnosis of
traumatic brain injury after 72 hours (12.3±29.4) was significantly lower compared to other patients
(08.3±73.7) (P<0.001).
Conclusion: While all four early warning scores were good at detecting ICU admission, there were
significant differences in their performance measures. The higher diagnostic accuracy of the National
Early Warning Score 2 makes it a valuable tool in identifying patients with traumatic brain injury.

Keywords

Early warning score
Trauma nursing
Intensive care units
Subjects
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Journal of Emergency Practice and Trauma
Volume 10, Issue 2
July 2024
Pages 90-96

  • Receive Date 25 March 2025
  • Revise Date 13 June 2025
  • Accept Date 09 July 2025

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