National Early Warning Score 2 (NEWS2) to identify inpatient COVID-19 deterioration: a retrospective analysis
Open Access
- 1 March 2021
- journal article
- research article
- Published by Elsevier BV in Clinical Medicine
- Vol. 21 (2), 84-89
- https://doi.org/10.7861/clinmed.2020-0688
Abstract
Introduction We sought to provide the first report of the use of NEWS2 monitoring to pre-emptively identify clinical deterioration within hospitalised COVID-19 patients. Methods Consecutive adult admissions with PCR-confirmed COVID-19 were included in this single-centre retrospective UK cohort study. We analysed all electronic clinical observations recorded within 28 days of admission until discharge or occurrence of a serious event, defined as any of the following: initiation of respiratory support, admission to intensive care, initiation of end of life care, or in-hospital death. Results 133/296 (44.9%) patients experienced at least one serious event. NEWS2 ≥ 5 heralded the first occurrence of a serious event with sensitivity 0.98 (95% CI 0.96–1.00), specificity 0.28 (0.21–0.35), positive predictive value (PPV) 0.53 (0.47–0.59), and negative predictive value (NPV) 0.96 (0.90–1.00). The NPV (but not PPV) of NEWS2 monitoring exceeded that of other early warning scores including the Modified Early Warning Score (MEWS) (0.59 [0.52–0.66], p<0.001) and quick Sepsis Related Organ Failure Assessment (qSOFA) score (0.58 [0.51–0.65], p<0.001). Conclusion Our results support the use of NEWS2 monitoring as a sensitive method to identify deterioration of hospitalised COVID-19 patients, albeit at the expense of a relatively high false-trigger rate.This publication has 24 references indexed in Scilit:
- Novel coronavirus disease (Covid-19): The first two patients in the UK with person to person transmissionJournal of Infection, 2020
- The National Early Warning Score: Translation, testing and prediction in a Swedish settingIntensive and Critical Care Nursing, 2016
- The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)JAMA, 2016
- National early warning score at Emergency Department triage may allow earlier identification of patients with severe sepsis and septic shock: a retrospective observational studyEmergency Medicine Journal, 2015
- Exploring the performance of the National Early Warning Score (NEWS) in a European emergency departmentResuscitation, 2015
- Validation of the National Early Warning Score in the prehospital settingResuscitation, 2015
- The ability of the National Early Warning Score (NEWS) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and deathResuscitation, 2013
- pROC: an open-source package for R and S+ to analyze and compare ROC curvesBMC Bioinformatics, 2011
- Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation studyThorax, 2003
- Validation of a modified Early Warning Score in medical admissionsQJM: An International Journal of Medicine, 2001