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Prognostic value of National Early Warning Scores (NEWS2) and component physiology in hospitalised patients with COVID-19: a multicentre study.
Scott, Lauren J; Tavaré, Alison; Hill, Elizabeth M; Jordan, Lesley; Juniper, Mark; Srivastava, Seema; Redfern, Emma; Little, Hannah; Pullyblank, Anne.
  • Scott LJ; NIHR ARC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK Lauren.Scott@bristol.ac.uk.
  • Tavaré A; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
  • Hill EM; West of England Academic Health Science Network, Bristol, UK.
  • Jordan L; NIHR ARC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
  • Juniper M; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
  • Srivastava S; Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.
  • Redfern E; West of England Academic Health Science Network, Bristol, UK.
  • Little H; Great Western Hospitals NHS Foundation Trust, Swindon, UK.
  • Pullyblank A; North Bristol NHS Trust, Bristol, UK.
Emerg Med J ; 39(8): 589-594, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1745680
ABSTRACT

BACKGROUND:

National Early Warning Scores (NEWS2) are used to detect all-cause deterioration. While studies have looked at NEWS2, the use of virtual consultation and remote monitoring of patients with COVID-19 mean there is a need to know which physiological observations are important.

AIM:

To investigate the relationship between outcome and NEWS2, change in NEWS2 and component physiology in COVID-19 inpatients.

METHODS:

A multi-centre retrospective study of electronically recorded, routinely collected physiological measurements between March and June 2020. First and maximum NEWS2, component scores and outcomes were recorded. Areas under the curve (AUCs) for 2-day, 7-day and 30-day mortality were calculated.

RESULTS:

Of 1263 patients, 26% died, 7% were admitted to intensive care units (ICUs) before discharge and 67% were discharged without ICU. Of 1071 patients with initial NEWS2, most values were low 50% NEWS2=0-2, 27% NEWS2=3-4, 14% NEWS2=5-6 and 9% NEWS2=7+. Maximum scores were 14% NEWS2=0-2, 22% NEWS2=3-4, 17% NEWS2=5-6 and 47% NEWS2=7+. Higher first and maximum scores were predictive of mortality, ICU admission and longer length of stay. AUCs based on 2-day, 7-day, 30-day and any hospital mortality were 0.77 (95% CI 0.70 to 0.84), 0.70 (0.65 to 0.74), 0.65 (0.61 to 0.68) and 0.65 (0.61 to 0.68), respectively. The AUCs for 2-day mortality were 0.71 (0.65 to 0.77) for supplemental oxygen, 0.65 (0.56 to 0.73) oxygen saturation and 0.64 (0.56 to 0.73) respiratory rate.

CONCLUSION:

While respiratory parameters were most predictive, no individual parameter was as good as a full NEWS2, which is an acceptable predictor of short-term mortality in patients with COVID-19. This supports recommendation to use NEWS2 alongside clinical judgement to assess patients with COVID-19.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Early Warning Score / COVID-19 Type of study: Diagnostic study / Observational study / Prognostic study Topics: Long Covid Limits: Humans Language: English Journal: Emerg Med J Journal subject: Emergency Medicine Year: 2022 Document Type: Article Affiliation country: Emermed-2020-210624

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Early Warning Score / COVID-19 Type of study: Diagnostic study / Observational study / Prognostic study Topics: Long Covid Limits: Humans Language: English Journal: Emerg Med J Journal subject: Emergency Medicine Year: 2022 Document Type: Article Affiliation country: Emermed-2020-210624