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National Early Warning Score 2 (NEWS2) to identify inpatient COVID-19 deterioration: a retrospective analysis

Kenneth F Baker, Aidan T Hanrath, Ina Schim van der Loeff, Lesley J Kay, Jonathan Back and Christopher JA Duncan
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DOI: https://doi.org/10.7861/clinmed.2020-0688
Clin Med March 2021
Kenneth F Baker
ATranslational and Clinical Research Institute, Newcastle University, UK and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
Roles: NIHR clinical lecturer
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Aidan T Hanrath
BTranslational and Clinical Research Institute, Newcastle University, UK
Roles: academic clinical fellow
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Ina Schim van der Loeff
BTranslational and Clinical Research Institute, Newcastle University, UK
Roles: academic clinical fellow
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Lesley J Kay
CTranslational and Clinical Research Institute, Newcastle University, UK, consultant rheumatologist, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK, and deputy medical director, Healthcare Safety Investigation Branch (HSIB), Farnborough, UK
Roles: honorary senior clinical lecturer
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Jonathan Back
DHealthcare Safety Investigation Branch (HSIB), Farnborough, UK
Roles: intelligence analyst
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Christopher JA Duncan
ETranslational and Clinical Research Institute, Newcastle University, UK, and honorary consultant in infectious diseases, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
Roles: Wellcome Trust clinical research career development fellow
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  • For correspondence: christopher.duncan@newcastle.ac.uk
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    Fig 1.

    Exclusion of patients prior to analysis.

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    Fig 2.

    Longitudinal trend in NEWS2 score in the deterioration group prior to occurrence of first serious event. Solid line shows fitted trend (loess regression), grey shading depicts 95% confidence intervals, dashed line shows score trigger threshold.

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    Table 1.

    Cohort clinical characteristics, stratified by occurrence of serious event

    DemographicNCohort (n=296) Any event (n=133)No event (n=163)p
    Male sex296162 (54.7)76 (57.1)86 (52.8)0.524
    Age (years)29675 (62–84) [23–101]76 (63–84) [32–97]74 (60–83) [23–101]0.132
    Symptom duration at admission (days)2964 (2–9) [0–42]5 (2–9) [0–21]4 (2–9) [0–42]0.386
    Clinical frailty score2944 (2–6) [1–9]5 (2–6) [1–9]4 (2–6) [1–7]0.103
    Nursing / residential home29660 (20.3)33 (24.8)27 (16.6)0.107
    WHO severe COVID-19 at admission293131 (44.7)86 / 131 (65.6)45 / 162 (27.7)<0.001
    CURB-65 score at admission2872 (1–2) (0–4)2 (1–3) [0–4]1 (1–2) [0–4]0.003
    Pneumonia on admission chest radiograph288114 (39.6)71 / 132 (53.8)43 / 156 (27.6)0.004
    Cumulative admission duration (days)2968 (4–14) [0–28]9 (5–18) [0–28]8 (3–12) [0–28]0.011
    Baseline NEWS2 score2965 (2–7) [0–16]6 (4–8) [0–16]3 (2–5) [0–11]<0.001
    Baseline MEWS score2962 (1–3) [0–9]3 (2–4) [0–9]2 (1–3) [0–9]<0.001
    Baseline qSOFA score2961 (0–1) [0–3]1 (0–1) [0–3]0 (0–1) [0–2]<0.001
    • Data are median (IQR) [range] for continuous variables, and n (%) or n/N (%) for categorical variables.

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    Table 2.

    Diagnostic metrics of NEWS2, MEWS and qSOFA score triggers for serious event within 24 hours

    MetricNEWS2MEWSqSOFA
    Sensitivity0.98 (0.96–1.00)0.39 (0.31–0.47)*0.32 (0.24–0.39)*
    Specificity0.28 (0.21–0.35)0.71 (0.64–0.78)*0.77 (0.71–0.84)*
    Positive predictive value0.53 (0.47–0.59)0.53 (0.43–0.62)ns0.53 (0.42–0.64)ns
    Negative predictive value0.96 (0.90–1.00)0.59 (0.52–0.66)*0.58 (0.51–0.65)*
    Positive likelihood ratio1.37 (1.24–1.51)1.36 (0.98–1.87)ns1.39 (0.95–2.03)ns
    Negative likelihood ratio0.05 (0.01–0.22)0.86 (0.72–1.01)*0.89 (0.77–1.02)*
    • ↵*p<0.001; ns = not significant (p>0.05) versus NEWS2.

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National Early Warning Score 2 (NEWS2) to identify inpatient COVID-19 deterioration: a retrospective analysis
Kenneth F Baker, Aidan T Hanrath, Ina Schim van der Loeff, Lesley J Kay, Jonathan Back, Christopher JA Duncan
Clinical Medicine Mar 2021, 21 (2) 84-89; DOI: 10.7861/clinmed.2020-0688

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National Early Warning Score 2 (NEWS2) to identify inpatient COVID-19 deterioration: a retrospective analysis
Kenneth F Baker, Aidan T Hanrath, Ina Schim van der Loeff, Lesley J Kay, Jonathan Back, Christopher JA Duncan
Clinical Medicine Mar 2021, 21 (2) 84-89; DOI: 10.7861/clinmed.2020-0688
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