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National Early Warning Score 2 (NEWS2) on admission predicts severe disease and in-hospital mortality from Covid-19 - a prospective cohort study.
Myrstad, Marius; Ihle-Hansen, Håkon; Tveita, Anders Aune; Andersen, Elizabeth Lyster; Nygård, Ståle; Tveit, Arnljot; Berge, Trygve.
  • Myrstad M; Department of Internal Medicine, Bærum Hospital Vestre Viken Hospital Trust, N-1346, Gjettum, Norway. marius.myrstad@vestreviken.no.
  • Ihle-Hansen H; Department of Medical Research, Bærum Hospital Vestre Viken Hospital Trust, N-1346, Gjettum, Norway. marius.myrstad@vestreviken.no.
  • Tveita AA; Department of Internal Medicine, Bærum Hospital Vestre Viken Hospital Trust, N-1346, Gjettum, Norway.
  • Andersen EL; Department of Medical Research, Bærum Hospital Vestre Viken Hospital Trust, N-1346, Gjettum, Norway.
  • Nygård S; Department of Internal Medicine, Bærum Hospital Vestre Viken Hospital Trust, N-1346, Gjettum, Norway.
  • Tveit A; K.G. Jebsen Centre for B cell malignancies, Department of Immunology and Transfusion Medicine, Oslo University Hospital, N-0372, Oslo, Norway.
  • Berge T; Department of Internal Medicine, Bærum Hospital Vestre Viken Hospital Trust, N-1346, Gjettum, Norway.
Scand J Trauma Resusc Emerg Med ; 28(1): 66, 2020 Jul 13.
Article in English | MEDLINE | ID: covidwho-2098371
ABSTRACT

BACKGROUND:

There is a need for validated clinical risk scores to identify patients at risk of severe disease and to guide decision-making during the covid-19 pandemic. The National Early Warning Score 2 (NEWS2) is widely used in emergency medicine, but so far, no studies have evaluated its use in patients with covid-19. We aimed to study the performance of NEWS2 and compare commonly used clinical risk stratification tools at admission to predict risk of severe disease and in-hospital mortality in patients with covid-19.

METHODS:

This was a prospective cohort study in a public non-university general hospital in the Oslo area, Norway, including a cohort of all 66 patients hospitalised with confirmed SARS-CoV-2 infection from the start of the pandemic; 13 who died during hospital stay and 53 who were discharged alive. Data were collected consecutively from March 9th to April 27th 2020. The main outcome was the ability of the NEWS2 score and other clinical risk scores at emergency department admission to predict severe disease and in-hospital mortality in covid-19 patients. We calculated sensitivity and specificity with 95% confidence intervals (CIs) for NEWS2 scores ≥5 and ≥ 6, quick Sequential Organ Failure Assessment (qSOFA) score ≥ 2, ≥2 Systemic Inflammatory Response Syndrome (SIRS) criteria, and CRB-65 score ≥ 2. Areas under the curve (AUCs) for the clinical risk scores were compared using DeLong's test.

RESULTS:

In total, 66 patients (mean age 67.9 years) were included. Of these, 23% developed severe disease. In-hospital mortality was 20%. Tachypnoea, hypoxemia and confusion at admission were more common in patients developing severe disease. A NEWS2 score ≥ 6 at admission predicted severe disease with 80.0% sensitivity and 84.3% specificity (Area Under the Curve (AUC) 0.822, 95% CI 0.690-0.953). NEWS2 was superior to qSOFA score ≥ 2 (AUC 0.624, 95% CI 0.446-0.810, p < 0.05) and other clinical risk scores for this purpose.

CONCLUSION:

NEWS2 score at hospital admission predicted severe disease and in-hospital mortality, and was superior to other widely used clinical risk scores in patients with covid-19.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Patient Admission / Pneumonia, Viral / Hospital Mortality / Coronavirus Infections / Betacoronavirus / Early Warning Score Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Scand J Trauma Resusc Emerg Med Journal subject: Emergency Medicine / Traumatology Year: 2020 Document Type: Article Affiliation country: S13049-020-00764-3

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Patient Admission / Pneumonia, Viral / Hospital Mortality / Coronavirus Infections / Betacoronavirus / Early Warning Score Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Scand J Trauma Resusc Emerg Med Journal subject: Emergency Medicine / Traumatology Year: 2020 Document Type: Article Affiliation country: S13049-020-00764-3