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. 2021 Feb 22;11(2):e043721.
doi: 10.1136/bmjopen-2020-043721.

Use of the first National Early Warning Score recorded within 24 hours of admission to estimate the risk of in-hospital mortality in unplanned COVID-19 patients: a retrospective cohort study

Donald Richardson  1 , Muhammad Faisal  2   3   4   5 , Massimo Fiori  6 , Kevin Beatson  6 , Mohammed Mohammed  7   8
Affiliations

Use of the first National Early Warning Score recorded within 24 hours of admission to estimate the risk of in-hospital mortality in unplanned COVID-19 patients: a retrospective cohort study

Donald Richardson et al. BMJ Open. .

Abstract

Objectives: Although the National Early Warning Score (NEWS) and its latest version NEWS2 are recommended for monitoring deterioration in patients admitted to hospital, little is known about their performance in COVID-19 patients. We aimed to compare the performance of the NEWS and NEWS2 in patients with COVID-19 versus those without during the first phase of the pandemic.

Design: A retrospective cross-sectional study.

Setting: Two acute hospitals (Scarborough and York) are combined into a single dataset and analysed collectively.

Participants: Adult (≥18 years) non-elective admissions discharged between 11 March 2020 and 13 June 2020 with an index or on-admission NEWS2 electronically recorded within ±24 hours of admission to predict mortality at four time points (in-hospital, 24 hours, 48 hours and 72 hours) in COVID-19 versus non-COVID-19 admissions.

Results: Out of 6480 non-elective admissions, 620 (9.6%) had a diagnosis of COVID-19. They were older (73.3 vs 67.7 years), more often male (54.7% vs 50.1%), had higher index NEWS (4 vs 2.5) and NEWS2 (4.6 vs 2.8) scores and higher in-hospital mortality (32.1% vs 5.8%). The c-statistics for predicting in-hospital mortality in COVID-19 admissions was significantly lower using NEWS (0.64 vs 0.74) or NEWS2 (0.64 vs 0.74), however, these differences reduced at 72hours (NEWS: 0.75 vs 0.81; NEWS2: 0.71 vs 0.81), 48 hours (NEWS: 0.78 vs 0.81; NEWS2: 0.76 vs 0.82) and 24hours (NEWS: 0.84 vs 0.84; NEWS2: 0.86 vs 0.84). Increasing NEWS2 values reflected increased mortality, but for any given value the absolute risk was on average 24% higher (eg, NEWS2=5: 36% vs 9%).

Conclusions: The index or on-admission NEWS and NEWS2 offers lower discrimination for COVID-19 admissions versus non-COVID-19 admissions. The index NEWS2 was not proven to be better than the index NEWS. For each value of the index NEWS/NEWS2, COVID-19 admissions had a substantially higher risk of mortality than non-COVID-19 admissions which reflects the increased baseline mortality risk of COVID-19.

Keywords: health & safety; health informatics; quality in health care.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Line plots showing the observed risk of in-hospital mortality with continuous covariates for COVID-19 (black colour) and non-COVID-19 (grey colour) admissions. Size of circles reflects sample size independently in the COVID-19 and non-COVID-19 groups. NEWS, National Early Warning Score.
Figure 2
Figure 2
Receiver operating characteristic curve for NEWS2 and NEWS in predicting the risk of in-hospital mortality, mortality within 24 hours, 48 hours and 72 hours in the COVID-19 (black colour) and non-COVID-19 (grey colour) admissions. NEWS, National Early Warning Score.
See this image and copyright information in PMC

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