scholarly journals The Prognostic Accuracy of National Early Warning Score 2 on Predicting Clinical Deterioration for Patients With COVID-19: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Kai Zhang ◽  
Xing Zhang ◽  
Wenyun Ding ◽  
Nanxia Xuan ◽  
Baoping Tian ◽  
...  
Keyword(s):  
Early Warning ◽  
Clinical Deterioration ◽  
Early Warning Score ◽  
Cochrane Library ◽  
Hospital Death ◽  
Likelihood Ratios ◽  
Prognostic Accuracy ◽  
National Early Warning Score ◽  
Sensitivity Specificity ◽  
Sensitive Method

Background: During the coronavirus disease 2019 (COVID-19) pandemic, the National Early Warning Score 2 (NEWS2) is recommended for the risk stratification of COVID-19 patients, but little is known about its ability to detect severe cases. Therefore, our purpose is to assess the prognostic accuracy of NEWS2 on predicting clinical deterioration for patients with COVID-19.Methods: We searched PubMed, Embase, Scopus, and the Cochrane Library from December 2019 to March 2021. Clinical deterioration was defined as the need for intensive respiratory support, admission to the intensive care unit, or in-hospital death. Sensitivity, specificity, and likelihood ratios were pooled by using the bivariate random-effects model. Overall prognostic performance was summarized by using the area under the curve (AUC). We performed subgroup analyses to assess the prognostic accuracy of NEWS2 in different conditions.Results: Eighteen studies with 6,922 participants were included. The NEWS2 of five or more was commonly used for predicting clinical deterioration. The pooled sensitivity, specificity, and AUC were 0.82, 0.67, and 0.82, respectively. Benefitting from adding a new SpO2 scoring scale for patients with hypercapnic respiratory failure, the NEWS2 showed better sensitivity (0.82 vs. 0.75) and discrimination (0.82 vs. 0.76) than the original NEWS. In addition, the NEWS2 was a sensitive method (sensitivity: 0.88) for predicting short-term deterioration within 72 h.Conclusions: The NEWS2 had moderate sensitivity and specificity in predicting the deterioration of patients with COVID-19. Our results support the use of NEWS2 monitoring as a sensitive method to initially assess COVID-19 patients at hospital admission, although it has a relatively high false-trigger rate. Our findings indicated that the development of enhanced or modified NEWS may be necessary.

scholarly journals National Early Warning Score 2 and laboratory predictors correlate with clinical deterioration in hospitalized patients with COVID-19

2021 ◽  
Author(s):  
Gulsah Tuncer ◽  
Serkan Surme ◽  
Osman F Bayramlar ◽  
Hatice K Karanalbant ◽  
Betul Copur ◽  
...  
Keyword(s):  
Early Warning ◽  
Odds Ratio ◽  
Hospitalized Patients ◽  
Clinical Deterioration ◽  
Early Warning Score ◽  
Hospital Death ◽  
Laboratory Parameters ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
National Early Warning Score

Aim: We aimed to determine the prognostic values of the National Early Warning Score 2 (NEWS2) and laboratory parameters during the first week of COVID-19. Materials & methods: All adult patients who were hospitalized for confirmed COVID-19 between 11 March and 11 May 2020 were retrospectively included. Results: Overall, 611 patients were included. Our results showed that NEWS2, procalcitonin, neutrophil/lymphocyte ratio and albumin at D0, D3, D5 and D7 were the best predictors for clinical deterioration defined as a composite of ICU admission during hospitalization or in-hospital death. Procalcitonin had the highest odds ratio for clinical deterioration on all days. Conclusion: This study provides a list of several laboratory parameters correlated with NEWS2 and potential predictors for clinical deterioration in patients with COVID-19.

scholarly journals National early warning score (NEWS) and the new alternative SpO2 scale during rapid response team reviews: a prospective observational study

2019 ◽  
Vol 27 (1) ◽  
Author(s):  
Joonas Tirkkonen ◽  
Sari Karlsson ◽  
Markus B. Skrifvars
Keyword(s):  
Observational Study ◽  
Early Warning ◽  
Prospective Observational Study ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Early Warning Score ◽  
Hospital Death ◽  
Hospital Patient ◽  
Response Team ◽  
National Early Warning Score

Abstract Background The national early warning score (NEWS) enables early detection of in-hospital patient deterioration and timely activation of hospital’s rapid response team (RRT). NEWS was updated in 2017 to include a separate SpO2 scale for those patients with type II respiratory failure (T2RF). In this study we investigated whether NEWS with and without the new SpO2 scale for the T2RF patients is associated with immediate and in-hospital patient outcomes among the patients actually attended by the RRT. Methods We conducted a two-year prospective observational study including all adult RRT patients without limitations of medical treatment (LOMT) in a large Finnish university associated tertiary level hospital. According to the first vital signs measured by the RRT, we calculated NEWSs for the RRT patients and further utilized the new SpO2 scale for the patients with confirmed T2RF. We used multivariate logistic regression and area under the receiver operating characteristic analyses to test NEWS’s accuracy to predict two distinct outcomes: RRT patient’s I) immediate need for intensive care and/or new LOMT and 2) in-hospital death or discharge with cerebral performance category >2 and/or LOMT. Results The final cohort consisted of 886 RRT patients attended for the first time during their hospitalization. Most common reasons for RRT activation were respiratory (343, 39%) and circulatory (226, 26%) problems. Cohort’s median (Q1, Q3) NEWS at RRT arrival was 8 (5, 10) and remained unchanged if the new SpO2 scale was applied for the 104 patients with confirmed T2RF. Higher NEWS was independently associated with both immediate (OR 1.28; 95% CI 1.22–1.35) and in-hospital (1.15; 1.10–1.21) adverse outcomes. Further, NEWS had fair discrimination for both the immediate (AUROC 0.73; 0.69–0.77) and in-hospital (0.68; 0.64–0.72) outcomes. Utilizing the new SpO2 scale for the patients with confirmed T2RF did not improve the discrimination capability (0.73; 0.69–0.76 and 0.68; 0.64–0.71) for these outcomes, respectively. Conclusions We found that in patients attended by a RRT, the NEWS predicts patient’s hospital outcome with moderate accuracy. We did not find any improvement using the new SpO2 scale in T2RF patients.

scholarly journals National Early Warning Score 2 (NEWS2) to predict poor outcome in hospitalised COVID-19 patients in India

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261376
Author(s):  
Pugazhvannan CR ◽  
Ilavarasi Vanidassane ◽  
Dhivya Pownraj ◽  
Ravichandran Kandasamy ◽  
Aneesh Basheer
Keyword(s):  
Risk Stratification ◽  
Early Warning ◽  
Area Under The Curve ◽  
Clinical Score ◽  
Supplemental Oxygen ◽  
Early Warning Score ◽  
National Early Warning Score ◽  
Poor Outcomes ◽  
Indian Setting ◽  
Sensitivity Specificity

Background While several parameters have emerged as predictors of prognosis of COVID-19, a simple clinical score at baseline might help early risk stratification. We determined the ability of National Early Warning Score 2 (NEWS2) to predict poor outcomes among adults with COVID-19. Methods A prospective study was conducted on 399 hospitalised adults with confirmed SARS-CoV-2 infection between August and December 2020. Baseline NEWS2 score was determined. Primary outcome was poor outcomes defined as need for mechanical ventilation or death within 28 days. The sensitivity, specificity and Area under the curve were determined for NEWS2 scores of 5 and 6. Results Mean age of patients was 55.5 ± 14.8 years and 275 of 399 (68.9%) were male. Overall mortality was 3.8% and 7.5% had poor outcomes. Median (interquartile range) NEWS2 score at admission was 2 (0–6). Sensitivity and specificity of NEWS 2 of 5 or more in predicting poor outcomes was 93.3% (95% CI: 76.5–98.8) and 70.7% (95% CI: 65.7–75.3) respectively [area under curve 0.88 (95% CI: 0.847–0.927)]. Age, baseline pulse rate, baseline oxygen saturation, need for supplemental oxygen and ARDS on chest X ray were independently associated with poor outcomes. Conclusions NEWS2 score of 5 or more at admission predicts poor outcomes in patients with COVID-19 with good sensitivity and can easily be applied for risk stratification at baseline. Further studies are needed in the Indian setting to validate this simple score and recommend widespread use.

scholarly journals National Early Warning Score (NEWS) at ICU discharge can predict early clinical deterioration after ICU transfer

2018 ◽  
Vol 43 ◽  
pp. 225-229 ◽  
Author(s):  
Supattra Uppanisakorn ◽  
Rungsun Bhurayanontachai ◽  
Jaruwan Boonyarat ◽  
Julawan Kaewpradit
Keyword(s):  
Early Warning ◽  
Clinical Deterioration ◽  
Early Warning Score ◽  
Icu Discharge ◽  
Icu Transfer ◽  
National Early Warning Score

scholarly journals Prehospital Point-Of-Care Lactate Increases the Prognostic Accuracy of National Early Warning Score 2 for Early Risk Stratification of Mortality: Results of a Multicenter, Observational Study

2020 ◽  
Vol 9 (4) ◽  
pp. 1156 ◽  
Author(s):  
Francisco Martín-Rodríguez ◽  
Raúl López-Izquierdo ◽  
Juan F. Delgado Benito ◽  
Ancor Sanz-García ◽  
Carlos del Pozo Vegas ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Early Warning ◽  
Life Support ◽  
Low Risk ◽  
Early Warning Score ◽  
Multicenter Observational Study ◽  
Risk Of Death ◽  
Prognostic Accuracy ◽  
Risk Of Mortality ◽  
National Early Warning Score

The objective of this study was to assess whether the use of prehospital lactate (pLA) can increase the prognostic accuracy of the National Early Warning Score 2 (NEWS2) to detect the risk of death within 48 h. A prospective, multicenter study in adults treated consecutively by the emergency medical services (EMS) included six advanced life support (ALS) services and five hospitals. Patients were assigned to one of four groups according to their risk of mortality (low, low-medium, medium, and high), as determined by the NEWS2 score. For each group, the validity of pLA in our cohort was assessed by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. In this study, 3081 participants with a median age of 69 years (Interquartile range (IQR): 54–81) were included. The two-day mortality was 4.4% (137 cases). The scale derived from the implementation of the pLA improved the capacity of the NEWS2 to discriminate low risk of mortality, with an AUC of 0.910 (95% CI: 0.87–0.94; p < 0.001). The risk stratification provided by the NEWS2 can be improved by incorporating pLA measurement to more accurately predict the risk of mortality in patients with low risk.

scholarly journals Investigation into the predictive capability for mortality and the trigger points of the National Early Warning Score 2 (NEWS2) in emergency department patients

2021 ◽  
pp. emermed-2020-210190
Author(s):  
Huw Masson ◽  
John Stephenson
Keyword(s):  
Early Warning ◽  
Trigger Point ◽  
Characteristic Curve ◽  
Trigger Points ◽  
Early Warning Score ◽  
Likelihood Ratios ◽  
Male Sex ◽  
National Early Warning Score ◽  
Emergency Department Patients ◽  
The Relationship

IntroductionNational Early Warning Score 2 (NEWS2) is widely used to monitor and trigger assessment throughout a patient’s hospital journey. Since the development and role out of NEWS2, its ability to predict mortality has been assessed in several settings, although to date not within an undifferentiated ED population.MethodsWe conducted a retrospective observational study of all adult ED attendees at two EDs in Northern England, between March and November 2019. Multilevel multiple logistic regression analyses were conducted on patient episode data to assess the relationship between mortality at 2, 7 and 30 days from attendances; and maximum NEWS2, adjusting for age, sex, arrival mode and triage priority.ResultsData were collected from 91 871 valid patient episodes associated with 64 760 patients. NEWS2 was a significant predictor of mortality at 2 days (OR 1.75; 95% CI 1.58 to 1.93); at 7 days (OR 1.69; 95% CI 1.59 to 1.80); at 30 days (OR 1.58; 95% CI 1.52 to 1.64). For the analyses of categorised NEWS2, NEWS2 of 2–20 was significantly associated with mortality at 2, 7 and 30 days compared with none assigned: OR 3.54 (95% CI 2.15 to 5.85) at 2 days; OR 6.05 (95% CI 3.92 to 9.34) at 7 days; OR 12.4 (95% CI 7.91 to 19.3) at 30 days. Increasing age, male sex, arrival by ambulance and higher triage categories were also associated with significantly increased mortality. Area under the receiver operating characteristic curve values of 0.963, 0.946 and 0.915, respectively, were recorded for mortality outcomes, with optimum likelihood ratios associated with a trigger of 4 NEWS2 points.ConclusionsNEWS2 is an effective predictor of mortality for patients presenting to the ED. Findings suggest that maximum NEWS2 of 4 and over may be the best trigger point for escalation of treatment. Findings also suggest a NEWS2 of 0–1 can identify a very low-risk group within the ED.

scholarly journals National Early Warning Score Does Not Accurately Predict Mortality for Patients With Infection Outside the Intensive Care Unit: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Kai Zhang ◽  
Xing Zhang ◽  
Wenyun Ding ◽  
Nanxia Xuan ◽  
Baoping Tian ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Sensitivity And Specificity ◽  
Early Warning ◽  
Adverse Outcomes ◽  
Early Warning Score ◽  
Predictive Tool ◽  
Prognostic Accuracy ◽  
Prediction Of Mortality ◽  
National Early Warning Score

Background: The prognostic value of the national early warning score (NEWS) in patients with infections remains controversial. We aimed to evaluate the prognostic accuracy of NEWS for prediction of in-hospital mortality in patients with infections outside the intensive care unit (ICU).Methods: We searched PubMed, Embase, and Scopus for related articles from January 2012 to April 2021. Sensitivity, specificity, and likelihood ratios were pooled by using the bivariate random-effects model. Overall prognostic performance was summarized by using the area under the curve (AUC). We performed subgroup analyses to assess the prognostic accuracy of NEWS in selected populations.Results: A total of 21 studies with 107,008 participants were included. The pooled sensitivity and specificity of NEWS were 0.71 and 0.60. The pooled AUC of NEWS was 0.70, which was similar to quick sequential organ failure assessment (qSOFA, AUC: 0.70) and better than systemic inflammatory response syndrome (SIRS, AUC: 0.60). However, the sensitivity (0.55) and AUC (0.63) of NEWS were poor in elder patients. The NEWS of 5 was more sensitive, which was a better threshold for activating urgent assessment and treatment.Conclusions: The NEWS had good diagnostic accuracy for early prediction of mortality in patients with infections outside the ICU, and the sensitivity and specificity were more moderate when compared with qSOFA and SIRS. Insufficient sensitivity and poor performance in the elder population may have limitations as an early warning score for adverse outcomes. NEWS should be used for continuous monitoring rather than a single time point predictive tool.

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