COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Clinical Prediction Guide Baker KF, Hanrath AT, van der Loeff IS, et al. National Early Warning Score 2 (NEWS2) to identify inpatient COVID-19 deterioration: a retrospective analysis. Clin Med (Lond). 2021 Feb 5. pii: clinmed.2020-0688. doi: 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.

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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.