COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Clinical Prediction Guide Myrstad M, Ihle-Hansen H, Tveita AA, et al. National Early Warning Score 2 (NEWS2) on admission predicts severe disease and in-hospital mortality from Covid-19 - a prospective cohort study. Scand J Trauma Resusc Emerg Med. 2020 Jul 13;28(1):66. doi: 10.1186/s13049-020-00764-3.

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.

Discipline / Specialty Area Score
Emergency Medicine
Hospital Doctor/Hospitalists
Internal Medicine
Infectious Disease
Intensivist/Critical Care
Comments from MORE raters

Emergency Medicine rater

Small study with an interesting result that is somewhat predictable.

Intensivist/Critical Care rater

Interesting study that was performed on a small number of patients.

Internal Medicine rater

This is a very pertinent paper that needs to be publicized because of the important question the authors ask. The lack of a proper comparison group is striking; yet the results seem encouraging and warrant more studies to establish NEWS 2 as a useful and simple predictor of severe COVID disease. A single estimate of the score may have added to some bias as serial NEWS 2 scores might have given a much more realistic picture of the disease progression.

Respirology/Pulmonology rater

This potentially useful COVID-19 risk score needs to be validated in an independent cohort.