COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

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Clinical Prediction Guide Pokeerbux MR, Yelnik CM, Faure E, et al. National early warning score to predict intensive care unit transfer and mortality in COVID-19 in a French cohort. Int J Clin Pract. 2021 Mar 1:e14121. doi: 10.1111/ijcp.14121.
Abstract

BACKGROUND: No risk stratification tool has been validated in hospitalised patients with coronavirus disease 2019 (COVID-19), despite a high rate of intensive care requirement and in-hospital mortality. We aimed to determine whether the National Early Warning Score (NEWS) at admission can accurately predict in-hospital mortality and ICU transfer.

METHODS: This was a retrospective cohort study from January 24 to April 16, 2020, at Lille University Hospital. All consecutive adult patients with laboratory-confirmed COVID-19 who were initially admitted to non-ICU wards were included. The primary outcome was a composite criterion consisting of ICU transfer or in-hospital mortality. We evaluated the prognostic performance of NEWS by calculating the area under (AUC) the receiver operating characteristic curve, the optimal threshold value of NEWS, and its association with the primary outcome.

RESULTS: Of the 202 COVID-19 patients, the median age was 65 (interquartile range 52-78), 38.6% were women and 136 had at least one comorbidity. The median NEWS was 4 (2-6). A total of 65 patients were transferred to the ICU or died in the hospital. Compared with patients with favourable outcome, these patients were significantly older, had more comorbidities and higher NEWS. The AUC for NEWS was 0.68 (0.60-0.77) and the best cutoff value was 6. Adjusted odds ratio for NEWS = 6 as an independent predictor was 3.78 (1.94-7.09).

CONCLUSIONS: In hospitalised COVID-19 patients, NEWS was an independent predictor of ICU transfer and in-hospital death. In daily practice, NEWS = 6 at admission may help to identify patients who are at risk to deteriorate.

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

Intensivist/Critical Care rater

This is a cohort study evaluating the NEWS early warning score as a predictor of outcome in COVID-19. Although interesting, this is preliminary work that should be validated in the future and wouldn't change current practice for most clinicians.

Internal Medicine rater

This may be less relevant if hopefully we have no more surges and bed availability issues, but still useful.