COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Clinical Prediction Guide Baker KF, Hanrath AT, Schim van der Loeff I, et al. National Early Warning Score 2 (NEWS2) to identify inpatient COVID-19 deterioration: a retrospective analysis. Clin Med (Lond). 2021 Mar;21(2):84-89. doi: 10.7861/clinmed.2020-0688. Epub 2021 Feb 5.
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.

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

Hospital Doctor/Hospitalists rater

NEWS is already used throughout the UK, so I'm not sure how this will change practice. This is a small cohort in a single centre with likely similar practice.

Infectious Disease rater

Is there a need for such a scoring system when we already have others? This makes things more complicated!

Intensivist/Critical Care rater

During the COVID-19 pandemic era, it is very important to prevent serious physiological complications. We need to use any effective parameter and/or score to estimate the illness. In this manuscript, the authors showed a possible score which might be useful for patient's care.

Intensivist/Critical Care rater

Scoring systems have established roles in modern medical care. In the specific COVID-19 scenario, a percentage of patients experience rapid deterioration of their clinical status, which makes the development of early warning scores a priority.

Respirology/Pulmonology rater

This relatively small retrospective cohort study suggests that NEWS2, an automated monitoring system employed ay NHS hospitals in the UK, functions well to predict deterioration in Covid-19 patients. This will need prospective assessment to see if it holds true.