Current best evidence for clinical care (more info)
PURPOSE: Clinical scores to rapidly assess the severity illness of Coronavirus Disease 2019 (COVID-19) could be considered of help for clinicians. Recently, a specific score (named COVID-GRAM) for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection, based on a nationwide Chinese cohort, has been proposed. We routinely applied the National Early Warning Score 2 (NEWS2) to predict critical COVID-19. Aim of this study is to compare NEWS2 and COVID-GRAM score.
METHODS: We retrospectively analysed data of 121 COVID-19 patients admitted in two Clinics of Infectious Diseases in the Umbria region, Italy. The primary outcome was critical COVID-19 illness defined as admission to the intensive care unit, invasive ventilation, or death. Accuracy of the scores was evaluated with the area under the receiver-operating characteristic curve (AUROC). Differences between scores were confirmed used Hanley-McNeil test.
RESULTS: The NEWS2 AUROC curve measured 0.87 (standard error, SE 0.03; 95% CI 0.80-0.93; p < 0.0001). The COVID-GRAM score AUROC curve measured 0.77 (SE 0.04; 95% CI 0.68-0.85; p < 0.0001). Hanley-McNeil test showed that NEWS2 better predicted severe COVID-19 (Z = 2.03).
CONCLUSIONS: The NEWS2 showed superior accuracy to COVID-GRAM score for prediction of critical COVID-19 illness.
|Discipline / Specialty Area||Score|
Useful, but not very surprising news.
While a variety of clinical prediction rules were derived in the early phases of the pandemic, more recently the utility of older models for critical illness in risk-stratifying COVID-19 has been demonstrated. The NEWS2 score is readily available in patients with potentially critical illness and may already be familiar to many hospitalists and intensivists. This paper demonstrates its superiority over newer, less well-validated tools like COVID-GRAM.
As a clinician, I find these results interesting and mark the importance of identifing early patients in risk of progression to critical COVID-19. That NEWS2 score is acurate and simple to apply at the patient bedside.