tetano
Editor, Senior Moderator
Open Forum Infect Dis
. 2021 Aug 10;8(12)
fab421.
doi: 10.1093/ofid/ofab421. eCollection 2021 Dec.
Predictive Value of an Age-Based Modification of the National Early Warning System in Hospitalized Patients With COVID-19
Ryan C Maves[SUP] 1 2 3 [/SUP], Stephanie A Richard[SUP] 1 4 [/SUP], David A Lindholm[SUP] 5 6 [/SUP], Nusrat Epsi[SUP] 1 4 [/SUP], Derek T Larson[SUP] 7 [/SUP], Christian Conlon[SUP] 8 [/SUP], Kyle Everson[SUP] 8 [/SUP], Steffen Lis[SUP] 8 [/SUP], Paul W Blair[SUP] 9 10 [/SUP], Sharon Chi[SUP] 1 4 11 [/SUP], Anuradha Ganesan[SUP] 1 4 12 [/SUP], Simon Pollett[SUP] 1 4 [/SUP], Timothy H Burgess[SUP] 1 [/SUP], Brian K Agan[SUP] 1 4 [/SUP], Rhonda E Colombo[SUP] 1 4 8 [/SUP], Christopher J Colombo[SUP] 6 8 [/SUP], EPICC COVID-19 Cohort Study Group
Collaborators, Affiliations
Abstract
Background: Early recognition of high-risk patients with coronavirus disease 2019 (COVID-19) may improve outcomes. Although many predictive scoring systems exist, their complexity may limit utility in COVID-19. We assessed the prognostic performance of the National Early Warning Score (NEWS) and an age-based modification (NEWS+age) among hospitalized COVID-19 patients enrolled in a prospective, multicenter US Military Health System (MHS) observational cohort study.
Methods: Hospitalized adults with confirmed COVID-19 not requiring invasive mechanical ventilation at admission and with a baseline NEWS were included. We analyzed each scoring system's ability to predict key clinical outcomes, including progression to invasive ventilation or death, stratified by baseline severity (low [0-3], medium [4-6], and high [≥7]).
Results: Among 184 included participants, those with low baseline NEWS had significantly shorter hospitalizations (P < .01) and lower maximum illness severity (P < .001). Most (80.2%) of low NEWS vs 15.8% of high NEWS participants required no or at most low-flow oxygen supplementation. Low NEWS (≤3) had a negative predictive value of 97.2% for progression to invasive ventilation or death; a high NEWS (≥7) had high specificity (93.1%) but low positive predictive value (42.1%) for such progression. NEWS+age performed similarly to NEWS at predicting invasive ventilation or death (NEWS+age: area under the receiver operating characteristics curve [AUROC], 0.69; 95% CI, 0.65-0.73; NEWS: AUROC, 0.70; 95% CI, 0.66-0.75).
Conclusions: NEWS and NEWS+age showed similar test characteristics in an MHS COVID-19 cohort. Notably, low baseline scores had an excellent negative predictive value. Given their easy applicability, these scoring systems may be useful in resource-limited settings to identify COVID-19 patients who are unlikely to progress to critical illness.
Keywords: COVID-19; early warning score; prognosis.
. 2021 Aug 10;8(12)
fab421.doi: 10.1093/ofid/ofab421. eCollection 2021 Dec.
Predictive Value of an Age-Based Modification of the National Early Warning System in Hospitalized Patients With COVID-19
Ryan C Maves[SUP] 1 2 3 [/SUP], Stephanie A Richard[SUP] 1 4 [/SUP], David A Lindholm[SUP] 5 6 [/SUP], Nusrat Epsi[SUP] 1 4 [/SUP], Derek T Larson[SUP] 7 [/SUP], Christian Conlon[SUP] 8 [/SUP], Kyle Everson[SUP] 8 [/SUP], Steffen Lis[SUP] 8 [/SUP], Paul W Blair[SUP] 9 10 [/SUP], Sharon Chi[SUP] 1 4 11 [/SUP], Anuradha Ganesan[SUP] 1 4 12 [/SUP], Simon Pollett[SUP] 1 4 [/SUP], Timothy H Burgess[SUP] 1 [/SUP], Brian K Agan[SUP] 1 4 [/SUP], Rhonda E Colombo[SUP] 1 4 8 [/SUP], Christopher J Colombo[SUP] 6 8 [/SUP], EPICC COVID-19 Cohort Study Group
Collaborators, Affiliations
- PMID: 34877361
- PMCID: PMC8643671
- DOI: 10.1093/ofid/ofab421
Abstract
Background: Early recognition of high-risk patients with coronavirus disease 2019 (COVID-19) may improve outcomes. Although many predictive scoring systems exist, their complexity may limit utility in COVID-19. We assessed the prognostic performance of the National Early Warning Score (NEWS) and an age-based modification (NEWS+age) among hospitalized COVID-19 patients enrolled in a prospective, multicenter US Military Health System (MHS) observational cohort study.
Methods: Hospitalized adults with confirmed COVID-19 not requiring invasive mechanical ventilation at admission and with a baseline NEWS were included. We analyzed each scoring system's ability to predict key clinical outcomes, including progression to invasive ventilation or death, stratified by baseline severity (low [0-3], medium [4-6], and high [≥7]).
Results: Among 184 included participants, those with low baseline NEWS had significantly shorter hospitalizations (P < .01) and lower maximum illness severity (P < .001). Most (80.2%) of low NEWS vs 15.8% of high NEWS participants required no or at most low-flow oxygen supplementation. Low NEWS (≤3) had a negative predictive value of 97.2% for progression to invasive ventilation or death; a high NEWS (≥7) had high specificity (93.1%) but low positive predictive value (42.1%) for such progression. NEWS+age performed similarly to NEWS at predicting invasive ventilation or death (NEWS+age: area under the receiver operating characteristics curve [AUROC], 0.69; 95% CI, 0.65-0.73; NEWS: AUROC, 0.70; 95% CI, 0.66-0.75).
Conclusions: NEWS and NEWS+age showed similar test characteristics in an MHS COVID-19 cohort. Notably, low baseline scores had an excellent negative predictive value. Given their easy applicability, these scoring systems may be useful in resource-limited settings to identify COVID-19 patients who are unlikely to progress to critical illness.
Keywords: COVID-19; early warning score; prognosis.