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S97 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)
  1. L Fox1,
  2. I Kostakis2,
  3. C Price3,
  4. G Smith3,
  5. D Prytherch2,
  6. P Meredith1,
  7. A Chauhan1
  1. 1Portsmouth Hospitals University NHS Trust, Portsmouth, UK
  2. 2University of Portsmouth, Portsmouth, UK
  3. 3Bournemouth University, Bournemouth, UK

Abstract

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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