scholarly journals Early warning scores to assess the probability of critical illness in patients with COVID-19

2021 ◽  
pp. emermed-2020-211054
Author(s):  
Lars Veldhuis ◽  
Milan L Ridderikhof ◽  
Michiel Schinkel ◽  
Joop van den Bergh ◽  
Martijn Beudel ◽  
...  
Keyword(s):  
Early Warning ◽  
Severe Disease ◽  
Early Warning Score ◽  
Risk Scores ◽  
Operating Characteristics ◽  
Icu Patients ◽  
Icu Admission ◽  
Clinical Risk ◽  
High Flow Oxygen ◽  
Early Warning Scores

ObjectiveValidated clinical risk scores are needed to identify patients with COVID-19 at risk of severe disease and to guide triage decision-making during the COVID-19 pandemic. The objective of the current study was to evaluate the performance of early warning scores (EWS) in the ED when identifying patients with COVID-19 who will require intensive care unit (ICU) admission for high-flow-oxygen usage or mechanical ventilation.MethodsPatients with a proven SARS-CoV-2 infection with complete resuscitate orders treated in nine hospitals between 27 February and 30 July 2020 needing hospital admission were included. Primary outcome was the performance of EWS in identifying patients needing ICU admission within 24 hours after ED presentation.ResultsIn total, 1501 patients were included. Median age was 71 (range 19–99) years and 60.3% were male. Of all patients, 86.9% were admitted to the general ward and 13.1% to the ICU within 24 hours after ED admission. ICU patients had lower peripheral oxygen saturation (86.7% vs 93.7, p≤0.001) and had a higher body mass index (29.2 vs 27.9 p=0.043) compared with non-ICU patients. National Early Warning Score 2 (NEWS2) ≥ 6 and q-COVID Score were superior to all other studied clinical risk scores in predicting ICU admission with a fair area under the receiver operating characteristics curve of 0.740 (95% CI 0.696 to 0.783) and 0.760 (95% CI 0.712 to 0.800), respectively. NEWS2 ≥6 and q-COVID Score ≥3 discriminated patients admitted to the ICU with a sensitivity of 78.1% and 75.9%, and specificity of 56.3% and 61.8%, respectively.ConclusionIn this multicentre study, the best performing models to predict ICU admittance were the NEWS2 and the Quick COVID-19 Severity Index Score, with fair diagnostic performance. However, due to the moderate performance, these models cannot be clinically used to adequately predict the need for ICU admission within 24 hours in patients with SARS-CoV-2 infection presenting at the ED.

scholarly journals National Early Warning Score 2 (NEWS2) on admission predicts severe disease and in-hospital mortality from Covid-19 - A prospective cohort study

2020 ◽  
Author(s):  
Marius Myrstad ◽  
Håkon Ihle-Hansen ◽  
Anders Aune Tveita ◽  
Elizabeth Lyster Andersen ◽  
Ståle Nygård ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Mortality ◽  
Early Warning ◽  
Prospective Cohort ◽  
Severe Disease ◽  
Early Warning Score ◽  
Risk Scores ◽  
Clinical Risk ◽  
National Early Warning Score ◽  
Qsofa Score

Abstract Background There is a need for validated clinical risk scores to identify patients at risk of severe disease and to guide decision-making during the covid-19 pandemic. The National Early Warning Score 2 (NEWS2) is widely used in emergency medicine, but so far, no studies have evaluated its use in patients with covid-19. We aimed to study the performance of NEWS2 and compare commonly used clinical risk stratification tools at admission to predict risk of severe disease and in-hospital mortality in patients with covid-19. Methods This was a prospective cohort study in a public non-university general hospital in the Oslo area, Norway, including a cohort of all 66 patients hospitalised with confirmed SARS-CoV-2 infection from the start of the pandemic; 13 who died during hospital stay and 53 who were discharged alive. Data were collected consecutively from March 9th to April 27th 2020. The main outcome was the ability of the NEWS2 score and other clinical risk scores at emergency department admission to predict severe disease and in-hospital mortality in covid-19 patients. We calculated sensitivity and specificity with 95% confidence intervals (CIs) for NEWS2 scores ≥ 5 and ≥ 6, quick Sequential Organ Failure Assessment (qSOFA) score ≥ 2, ≥2 Systemic Inflammatory Response Syndrome (SIRS) criteria, and CRB-65 score ≥ 2. Areas under the curve (AUCs) for the clinical risk scores were compared using DeLong’s test. Results In total, 66 patients (mean age 67.9 years) were included. Of these, 23% developed severe disease. In-hospital mortality was 20%. Tachypnoea, hypoxemia and confusion at admission were more common in patients developing severe disease. A NEWS2 score ≥ 6 at admission predicted severe disease with 80.0% sensitivity and 84.3% specificity (Area Under the Curve (AUC) 0.822, 95% confidence interval (CI) 0.690–0.953). NEWS2 was superior to qSOFA score ≥ 2 (AUC 0.624, 95% CI 0.446–0.810, p < 0.05) and other clinical risk scores for this purpose. Conclusion NEWS2 score at hospital admission predicted severe disease and in-hospital mortality, and was superior to other widely used clinical risk scores in patients with covid-19.

scholarly journals National Early Warning Score 2 (NEWS2) on admission predicts severe disease and in-hospital mortality from Covid-19 - A prospective cohort study

2020 ◽  
Author(s):  
Marius Myrstad ◽  
Håkon Ihle-Hansen ◽  
Anders Aune Tveita ◽  
Elizabeth Lyster Andersen ◽  
Ståle Nygård ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Mortality ◽  
Early Warning ◽  
Prospective Cohort ◽  
Severe Disease ◽  
Early Warning Score ◽  
Risk Scores ◽  
Clinical Risk ◽  
National Early Warning Score ◽  
Qsofa Score

Abstract Background There is a need for validated clinical risk scores to identify patients at risk of severe disease and to guide decision-making during the covid-19 pandemic. The National Early Warning Score 2 (NEWS2) is widely used in emergency medicine, but so far, no studies have evaluated its use in patients with covid-19. We aimed to study the performance of NEWS2 and compare commonly used clinical risk stratification tools at admission to predict risk of severe disease and in-hospital mortality in patients with covid-19. Methods This was a prospective cohort study in a public non-university general hospital in the Oslo area, Norway, including a cohort of all 66 patients hospitalised with confirmed SARS-CoV-2 infection from the start of the pandemic; 13 who died during hospital stay and 53 who were discharged alive. Data were collected consecutively from March 9th to April 27th 2020. The main outcome was the ability of the NEWS2 score and other clinical risk scores at emergency department admission to predict severe disease and in-hospital mortality in covid-19 patients. We calculated sensitivity and specificity with 95% confidence intervals (CIs) for NEWS2 scores ≥5 and ≥6, quick Sequential Organ Failure Assessment (qSOFA) score ≥2, ≥2 Systemic Inflammatory Response Syndrome (SIRS) criteria, and CRB-65 score ≥2. Areas under the curve (AUCs) for the clinical risk scores were compared using DeLong’s test.Results In total, 66 patients (mean age 67.9 years) were included. Of these, 23% developed severe disease. In-hospital mortality was 20%. Tachypnoea, hypoxemia and confusion at admission were more common in patients developing severe disease. A NEWS2 score ≥6 at admission predicted severe disease with 80.0% sensitivity and 84.3% specificity (Area Under the Curve (AUC) 0.822, 95% confidence interval (CI) 0.690-0.953). NEWS2 was superior to qSOFA score ≥2 (AUC 0.624, 95% CI 0.446-0.810, p<0.05) and other clinical risk scores for this purpose.Conclusion NEWS2 score at hospital admission predicted severe disease and in-hospital mortality, and was superior to other widely used clinical risk scores in patients with covid-19.

scholarly journals Early identification of severe community-acquired pneumonia: a retrospective observational study

2019 ◽  
Vol 6 (1) ◽  
pp. e000438 ◽  
Author(s):  
Frances S Grudzinska ◽  
Kerrie Aldridge ◽  
Sian Hughes ◽  
Peter Nightingale ◽  
Dhruv Parekh ◽  
...  
Keyword(s):  
Early Warning ◽  
Assessment Tool ◽  
Characteristic Curve ◽  
Community Acquired Pneumonia ◽  
Adverse Outcomes ◽  
Assessment Tools ◽  
Early Warning Score ◽  
News Medium ◽  
Increased Risk ◽  
Early Warning Scores

BackgroundCommunity-acquired pneumonia (CAP) is a leading cause of sepsis worldwide. Prompt identification of those at high risk of adverse outcomes improves survival by enabling early escalation of care. There are multiple severity assessment tools recommended for risk stratification; however, there is no consensus as to which tool should be used for those with CAP. We sought to assess whether pneumonia-specific, generic sepsis or early warning scores were most accurate at predicting adverse outcomes.MethodsWe performed a retrospective analysis of all cases of CAP admitted to a large, adult tertiary hospital in the UK between October 2014 and January 2016. All cases of CAP were eligible for inclusion and were reviewed by a senior respiratory physician to confirm the diagnosis. The association between the CURB65, Lac-CURB-65, quick Sequential (Sepsis-related) Organ Failure Assessment tool (qSOFA) score and National Early Warning Score (NEWS) at the time of admission and outcome measures including intensive care admission, length of hospital stay, in-hospital, 30-day, 90-day and 365-day all-cause mortality was assessed.Results1545 cases were included with 30-day mortality of 19%. Increasing score was significantly associated with increased risk of poor outcomes for all four tools. Overall accuracy assessed by receiver operating characteristic curve analysis was significantly greater for the CURB65 and Lac-CURB-65 scores than qSOFA. At admission, a CURB65 ≥2, Lac-CURB-65 ≥moderate, qSOFA ≥2 and NEWS ≥medium identified 85.0%, 96.4%, 40.3% and 79.0% of those who died within 30 days, respectively. A Lac-CURB-65 ≥moderate had the highest negative predictive value: 95.6%.ConclusionAll four scoring systems can stratify according to increasing risk in CAP; however, when a confident diagnosis of pneumonia can be made, these data support the use of pneumonia-specific tools rather than generic sepsis or early warning scores.

Early Warning Score Communication Bundle: A Pilot Study

2018 ◽  
Vol 27 (3) ◽  
pp. 238-242
Author(s):  
Cheryl Gagne ◽  
Susan Fetzer
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Early Warning ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Early Warning Score ◽  
Early Warning Scores ◽  
Response Team ◽  
Intensive Care Unit Nurses ◽  
The Impact

Background Unplanned admissions of patients to intensive care units from medical-surgical units often result from failure to recognize clinical deterioration. The early warning score is a clinical decision support tool for nurse surveillance but must be communicated to nurses and implemented appropriately. A communication process including collaboration with experienced intensive care unit nurses may reduce unplanned transfers. Objective To determine the impact of an early warning score communication bundle on medical-surgical transfers to the intensive care unit, rapid response team calls, and morbidity of patients upon intensive care unit transfer. Methods After an early warning score was electronically embedded into medical records, a communication bundle including notification of and telephone collaboration between medical-surgical and intensive care unit nurses was implemented. Data were collected 3 months before and 21 months after implementation. Results Rapid response team calls increased nonsignificantly during the study period (from 6.47 to 8.29 per 1000 patient-days). Rapid response team calls for patients with early warning scores greater than 4 declined (from 2.04 to 1.77 per 1000 patient-days). Intensive care unit admissions of patients after rapid response team calls significantly declined (P = .03), as did admissions of patients with early warning scores greater than 4 (P = .01), suggesting that earlier intervention for patient deterioration occurred. Documented reassessment response time declined significantly to 28 minutes (P = .002). Conclusion Electronic surveillance and collaboration with experienced intensive care unit nurses may improve care, control costs, and save lives. Critical care nurses have a role in coaching and guiding less experienced nurses.

scholarly journals Use of paediatric early warning scores in intermediate care units

2019 ◽  
pp. archdischild-2019-317055
Author(s):  
Marie Emilie Lampin ◽  
Alain Duhamel ◽  
Hélène Behal ◽  
Morgan Recher ◽  
Francis Leclerc ◽  
...  
Keyword(s):  
Early Warning ◽  
Emergency Departments ◽  
Repeated Measures ◽  
Medical Intervention ◽  
Clinical Deterioration ◽  
Early Warning Score ◽  
Receiver Operating Curve ◽  
Intermediate Care ◽  
Derivation Cohort ◽  
Early Warning Scores

ObjectivePaediatric early warning scores (EWS) were developed to detect deterioration in paediatric wards or emergency departments. The aim of this study was to assess the relationship between three paediatric EWS and clinical deterioration detected by the nurse in paediatric intermediate care units (PImCU).MethodsThis was a prospective, observational, multicentre study at seven French regional hospitals that included all children <18 years of age. Clinical parameters included in three EWS (Paediatric Advanced Warning Score, Paediatric Early Warning Score and Bedside Paediatric Early Warning System) were prospectively recorded every 8 hours or in case of deterioration. The outcome was a call to physician by the nurse when a clinical deterioration was observed. The cohort was divided into derivation and validation cohorts. An updated methodology for repeated measures was used and discrimination was estimated by the area under the receiver-operating curve.ResultsA total of 2636 children were included for 14 708 observations to compute a posteriori the EWS. The discrimination of the three EWS for predicting calls to physicians by nurses was good (range: 0.87–0.91) for the derivation cohort and moderate (range: 0.71–0.76) for the validation cohort. Equations for probability thresholds of calls to physicians, taking into account the time t, the score at time t and the score at admission, are available.ConclusionThese three EWS developed for children in paediatric wards or emergency departments can be used in PImCU to detect a clinical deterioration and predict the need for medical intervention.

scholarly journals Development and validation of a clinical score to estimate progression to severe or critical state in COVID-19 pneumonia hospitalized patients

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Francisco Gude ◽  
Vanessa Riveiro ◽  
Nuria Rodríguez-Núñez ◽  
Jorge Ricoy ◽  
Óscar Lado-Baleato ◽  
...  
Keyword(s):  
Decision Making ◽  
Predictive Model ◽  
Disease Progression ◽  
Clinical Laboratory ◽  
Severe Disease ◽  
Invasive Mechanical Ventilation ◽  
Risk Scores ◽  
Brier Score ◽  
Operating Characteristics ◽  
Early Decision

AbstractThe prognosis of a patient with COVID-19 pneumonia is uncertain. Our objective was to establish a predictive model of disease progression to facilitate early decision-making. A retrospective study was performed of patients admitted with COVID-19 pneumonia, classified as severe (admission to the intensive care unit, mechanic invasive ventilation, or death) or non-severe. A predictive model based on clinical, laboratory, and radiological parameters was built. The probability of progression to severe disease was estimated by logistic regression analysis. Calibration and discrimination (receiver operating characteristics curves and AUC) were assessed to determine model performance. During the study period 1152 patients presented with SARS-CoV-2 infection, of whom 229 (19.9%) were admitted for pneumonia. During hospitalization, 51 (22.3%) progressed to severe disease, of whom 26 required ICU care (11.4); 17 (7.4%) underwent invasive mechanical ventilation, and 32 (14%) died of any cause. Five predictors determined within 24 h of admission were identified: Diabetes, Age, Lymphocyte count, SaO2, and pH (DALSH score). The prediction model showed a good clinical performance, including discrimination (AUC 0.87 CI 0.81, 0.92) and calibration (Brier score = 0.11). In total, 0%, 12%, and 50% of patients with severity risk scores ≤ 5%, 6–25%, and > 25% exhibited disease progression, respectively. A risk score based on five factors predicts disease progression and facilitates early decision-making according to prognosis.

scholarly journals Into the Night: Factors affecting response to abnormal Early Warning Scores out-of-hours and implications for service improvement

2014 ◽  
Vol 13 (2) ◽  
pp. 56-60
Author(s):  
C J Yiu ◽  
◽  
S U Khan ◽  
Christian P Subbe ◽  
K Tofeec ◽  
...  
Keyword(s):  
Nursing Staff ◽  
Early Warning ◽  
Service Evaluation ◽  
Early Warning Score ◽  
Service Improvement ◽  
Out Of Hours ◽  
Factors Affecting ◽  
Alarm Fatigue ◽  
Early Warning Scores ◽  
Medical Wards

Background: Early Warning Scores alert staff to preventable deterioration. Raised scores should lead to escalation of care. Aims: To establish response of staff to patients scoring National Early Warning Score (NEWS) of six or above and to identify patient and environmental factors affecting escalation by nursing staff. Methods: Service evaluation with prospective review of patient records of 118 beds on four medical wards during 20 night-shifts. Results: During 2360 observed bed days 109 patients triggered NEWS >=6 at least once during the observation period. Nursing staff escalated only 18 (17%) of these patients; nearly all of them had predefined chronic health conditions, the majority fulfilled criteria for frailty. Despite their higher 30-day mortality patients with COPD had lower escalation rates. Additionally wards that had more patients with a NEWS >=6 had lower escalation rates. Conclusion: Alarm fatigue and clinical judgement of staff might result in deviation from escalation protocols.

scholarly journals Comparison of early warning scores for sepsis early identification and prediction in the general ward setting

JAMIA Open ◽  
2021 ◽  
Vol 4 (3) ◽  
Author(s):  
Sean C Yu ◽  
Nirmala Shivakumar ◽  
Kevin Betthauser ◽  
Aditi Gupta ◽  
Albert M Lai ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Early Warning ◽  
Predictive Value ◽  
Early Identification ◽  
Academic Medical Center ◽  
Scoring Systems ◽  
General Ward ◽  
Early Warning Score ◽  
Patient Acuity ◽  
Early Warning Scores

Abstract The objective of this study was to directly compare the ability of commonly used early warning scores (EWS) for early identification and prediction of sepsis in the general ward setting. For general ward patients at a large, academic medical center between early-2012 and mid-2018, common EWS and patient acuity scoring systems were calculated from electronic health records (EHR) data for patients that both met and did not meet Sepsis-3 criteria. For identification of sepsis at index time, National Early Warning Score 2 (NEWS 2) had the highest performance (area under the receiver operating characteristic curve: 0.803 [95% confidence interval [CI]: 0.795–0.811], area under the precision recall curves: 0.130 [95% CI: 0.121–0.140]) followed NEWS, Modified Early Warning Score, and quick Sequential Organ Failure Assessment (qSOFA). Using validated thresholds, NEWS 2 also had the highest recall (0.758 [95% CI: 0.736–0.778]) but qSOFA had the highest specificity (0.950 [95% CI: 0.948–0.952]), positive predictive value (0.184 [95% CI: 0.169–0.198]), and F1 score (0.236 [95% CI: 0.220–0.253]). While NEWS 2 outperformed all other compared EWS and patient acuity scores, due to the low prevalence of sepsis, all scoring systems were prone to false positives (low positive predictive value without drastic sacrifices in sensitivity), thus leaving room for more computationally advanced approaches.

Sign in / Sign up

Export Citation Format

Share Document