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The ROX index has greater predictive validity than NEWS2 for deterioration in Covid-19.
Prower, Emma; Grant, David; Bisquera, Alessandra; Breen, Cormac P; Camporota, Luigi; Gavrilovski, Maja; Pontin, Megan; Douiri, Abdel; Glover, Guy W.
  • Prower E; Department of Critical Care, Kings College Hospital, Denmark Hill, London SE5 9RS, UK.
  • Grant D; Department of clinical informatics for health informatics, Guys and St Thomas NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK.
  • Bisquera A; Department of Primary Care and Public Health Sciences, Kings College London, Guy's Campus, Addison House, London SE1 1UL, UK.
  • Breen CP; Department of Nephrology, Guys and St Thomas NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK.
  • Camporota L; Department of Critical Care, Guys and St Thomas NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK.
  • Gavrilovski M; Department of Emergency Medicine, Guys and St Thomas NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.
  • Pontin M; Department of Quality and Assurance, Guy's and St Thomas NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.
  • Douiri A; Department of Primary Care and Public Health Sciences, Kings College London, Guy's Campus, Addison House, London, SE1 1UL, UK.
  • Glover GW; Department of Critical Care, Guys and St Thomas NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.
EClinicalMedicine ; 35: 100828, 2021 May.
Article in English | MEDLINE | ID: covidwho-1202164
ABSTRACT

BACKGROUND:

Patients admitted to hospital with Covid-19 are at risk of deterioration. The National Early Warning Score (NEWS2) is widely recommended, however it's validity in Covid-19 is not established and indices more specific for respiratory failure may be more appropriate. We aim to describe the physiological antecedents to deterioration, test the predictive validity of NEWS2 and compare this to the ROX index ([SpO2/FiO2]/respiratory rate).

METHOD:

A single centre retrospective cohort study of adult patients who were admitted to a medical ward, between 1/3/20 and 30/5/20, with positive results for SARS-CoV-2 RNA. Physiological observations and the NEWS2 were extracted and analysed. The primary outcome was a composite of cardiac arrest, unplanned critical care admission or death within 24 hours. A generalized linear model was used to assess the association of physiological values, NEWS2 and ROX with the outcome.

FINDINGS:

The primary outcome occurred in 186 patients (26%). In the preceding 24 hours, deterioration was most marked in respiratory parameters, specifically in escalating oxygen requirement; tachypnoea was a late sign, whilst cardiovascular observations remained stable. The area under the receiver operating curve was 0.815 (95% CI 0.804-0.826) for NEWS2 and 0.848 (95% CI 0.837-0.858) for ROX. Applying the optimal level of ROX, the majority of patients triggered four hours earlier than with NEWS2 of 5.

INTERPRETATION:

NEWS2 may under-perform in Covid-19 due to intrinsic limitations of the design and the unique pathophysiology of the disease. A simple index utilising respiratory parameters can outperform NEWS2 in predicting the occurrence of adverse events.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study Language: English Journal: EClinicalMedicine Year: 2021 Document Type: Article Affiliation country: J.eclinm.2021.100828

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study Language: English Journal: EClinicalMedicine Year: 2021 Document Type: Article Affiliation country: J.eclinm.2021.100828