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. 2021;3(9):1863-1869.
doi: 10.1007/s42399-021-00997-y. Epub 2021 Jun 18.

Modified National Early Warning Score as Early Predictor of Outcome in COVID-19 Pandemic

Fabio Tagliabue #  1 , Daniele Schena #  2 , Luca Galassi  1 , Matteo Magni  1 , Guglielmo Guerrazzi  3 , Andrea Acerbis  1 , Christina Rinallo  2 , Daniel Longhi  4 , Alberto Ronzani  5 , Pierpaolo Mariani  1
Affiliations

Modified National Early Warning Score as Early Predictor of Outcome in COVID-19 Pandemic

Fabio Tagliabue et al. SN Compr Clin Med. 2021.

Abstract

COVID-19 represented an important challenge to the Italian healthcare system (IHCS). Our main aim was to obtain evidence to support the use of modified national early warning score (m-NEWS) as an interdisciplinary, common, and universal scoring scale to quickly recognize patients with a risk of clinical deterioration before admission and during hospitalization. As a secondary goal, we tried to find a score threshold that can trigger patients' immediate medical review as a part of an optimal triaging protocol for an emergency setting where healthcare resources are overloaded. We performed a retrospective observational study. We included in our study all patients treated for COVID-19 infection in surgical departments between 01 March 2020 and 16 April 2020. Patients with negative test results for SARS-COV-2 were excluded. m-NEWS was obtained twice a day. Patients' m-NEWS were analyzed in order to verify the correlation between m-NEWS (at admission and m-NEWS variation 24 h after admission) and outcome (positive outcome-survival, negative outcome-death, or intensive care unit (ICU) transfer). We included a population-based sample of 225 SARS-COV-2-infected patients. Overall, the average age at hospitalization was 71 (ranging from 40 to 95). 144 (64%) patients were males and 81 (36%) females. m-NEWS values lower or equal to 7 were associated with the majority of the "recovered" population (100/132 75.75%) and at the same time with the minority of the "non-recovered" population (25/93 26.88%). For our sample, age is statistically correlated to the outcome but a triage protocol based solely on this variable is less effective than m-NEWS, which showed to be a reliable and easy-to-use score for first patient evaluation. Our observations pave the way towards further studies aiming at optimizing territorial and community healthcare management protocols.

Keywords: COVID-19; EWS; Respiratory failure; Score.

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Conflict of interest statement

Conflict of InterestAll authors declare that no support from any organization for the submitted work and no financial relationships with any organizations that might have an interest in the submitted work in the previous three years have been received. No other relationships or activities could appear to have influenced the submitted work.

Figures

Fig. 1
Fig. 1
Violin plot: summary of the probability density estimates of the variables age (a) and m-NEWS at admission (b) in our dataset
Fig. 2
Fig. 2
Variable distribution and cross-correlation in our statistical sample, classified by clinical outcome
Fig. 3
Fig. 3
Receiver operating characteristics (ROC) to compare the performance of age and m-NEWS at admission variables
See this image and copyright information in PMC

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