Introduction The National Early Warning Score (NEWS) and its update, NEWS2, are validated scoring systems for identifying patient deterioration in a range of clinical conditions, including infection and sepsis. Coronavirus disease 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has a variable clinical presentation from asymptomatic to life-threatening multi-organ failure. There is little research demonstrating NEWS/NEWS2 performance in COVID-19. Therefore, we sought to evaluate their predictive ability.
Methods In the study hospital, all patient vital signs are documented in real-time using commercially available, electronic software and we extracted this data. Using receiver-operating characteristic analyses, we used the area under the receiver operating characteristic (AUROC) curve to evaluate the performance of NEWS/NEWS2 to discriminate the combined outcome of either death or intensive care unit (ICU) admission within 24-hours of a vital sign set in five cohorts: COVID-19 positive (n=405), COVID-19 not-detected (n=1717), COVID-19 not tested (n=2952), Control 2018 (n=6275), Control 2019 (n=6524).
Results After exclusions, the main data extract (01/01/2018 – 03/05/20) contained 2,867,313 vital sign sets from 97,669 admissions. Admissions in the COVID-19 positive and COVID-19 not-detected cohorts were older (p<0.001), and those in the COVID-19 positive cohort were more likely to be male (p<0.001), with a higher mean EWS during their stay. Figure 1 demonstrates an increasing risk of the combined outcome with increasing NEWS/NEWS2 value in all 5 cohorts. The AUROC values for NEWS/NEWS2 for the combined outcome of either death or ICU admission were: COVID-19 positive 0.880 (0.866–0.894); COVID-19 not-detected 0.881 (0.867–0.895); COVID-19 not tested 0.869 (0.842–0.896); Control 2018 0.896 (0.886–0.906) and Control 2019 0.844 (0.831–0.857).
Conclusions This study demonstrates that NEWS/NEWS2 are good discriminators of either death or ICU admission within 24-hours of a vital sign set in patients with COVID-19. There was very little difference between the AUROC values in the COVID-19 positive cohort compared to any of our other study cohorts suggesting amendments to NEWS/NEWS2 are unnecessary when evaluating patients with COVID-19. Our results support the recommendations by the RCP, WHO and NICE for the use of NEWS/NEWS2 for the assessment of acute-illness severity in patients with COVID-19.
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