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. 2021 Feb:159:150-157.
doi: 10.1016/j.resuscitation.2020.10.039. Epub 2020 Nov 8.

The performance of the National Early Warning Score and National Early Warning Score 2 in hospitalised patients infected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

Ina Kostakis  1 , Gary B Smith  2 , David Prytherch  1 , Paul Meredith  3 , Connor Price  1 , Anoop Chauhan  4 ; Portsmouth Academic ConsortIum For Investigating COVID-19 (PACIFIC-19)
Collaborators, Affiliations

The performance of the National Early Warning Score and National Early Warning Score 2 in hospitalised patients infected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

Ina Kostakis et al. Resuscitation. 2021 Feb.

Abstract

Introduction: Since the introduction of the UK's National Early Warning Score (NEWS) and its modification, NEWS2, coronavirus disease 2019 (COVID-19), has caused a worldwide pandemic. NEWS and NEWS2 have good predictive abilities in patients with other infections and sepsis, however there is little evidence of their performance in COVID-19.

Methods: Using receiver-operating characteristics analyses, we used the area under the receiver operating characteristic (AUROC) curve to evaluate the performance of NEWS or NEWS2 to discriminate the combined outcome of either death or intensive care unit (ICU) admission within 24 h of a vital sign set in five cohorts (COVID-19 POSITIVE, n = 405; COVID-19 NOT DETECTED, n = 1716; COVID-19 NOT TESTED, n = 2686; CONTROL 2018, n = 6273; CONTROL 2019, n = 6523).

Results: The AUROC values for NEWS or NEWS2 for the combined outcome were: COVID-19 POSITIVE, 0.882 (0.868-0.895); COVID-19 NOT DETECTED, 0.875 (0.861-0.89); COVID-19 NOT TESTED, 0.876 (0.85-0.902); CONTROL 2018, 0.894 (0.884-0.904); CONTROL 2019, 0.842 (0.829-0.855).

Conclusions: The finding that NEWS or NEWS2 performance was good and similar in all five cohorts (range = 0.842-0.894) suggests that amendments to NEWS or NEWS2, such as the addition of new covariates or the need to change the weighting of existing parameters, are unnecessary when evaluating patients with COVID-19. Our results support the national and international recommendations for the use of NEWS or NEWS2 for the assessment of acute-illness severity in patients with COVID-19.

Keywords: Adverse events; Early warning scores; Intensive care unit admission; Mortality; Rapid response systems.

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Figures

Fig. 1
Fig. 1
Development of the datasets for each of the five study cohorts.
Fig. 2
Fig. 2
Distribution of NEWS or NEWS2 values for the five admission cohorts.
Fig. 3
Fig. 3
The relationship between NEWS or NEWS2 value and the risk of the combined outcome in all five cohorts.
Fig. 4
Fig. 4
Monthly area under the receiver operating characteristic (AUROC) curve values from 01/01/2018 to 31/12/2019 for NEWS or NEWS2 and the combined outcome.
See this image and copyright information in PMC

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References

    1. Royal College of Physicians (London) Report of a working party; 2012. National Early Warning Score (NEWS). Standardising the Assessment of Acute-Illness Severity in the NHS. July.
    1. Royal College of Physicians . Updated report of a working party; 2017. National Early Warning Score (NEWS) 2. Standardising the Assessment of Acute-Illness Severity in the NHS. December.
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