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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 February 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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ABSTRACT

Introduction We sought to provide the first report of the use of NEWS2 monitoring to pre-emptively identify clinical deterioration within hospitalised COVID-19 patients.

Methods Consecutive adult admissions with PCR-confirmed COVID-19 were included in this single-centre retrospective UK cohort study. We analysed all electronic clinical observations recorded within 28 days of admission until discharge or occurrence of a serious event, defined as any of the following: initiation of respiratory support, admission to intensive care, initiation of end of life care, or in-hospital death.

Results 133/296 (44.9%) patients experienced at least one serious event. NEWS2 ≥ 5 heralded the first occurrence of a serious event with sensitivity 0.98 (95% CI 0.96–1.00), specificity 0.28 (0.21–0.35), positive predictive value (PPV) 0.53 (0.47–0.59), and negative predictive value (NPV) 0.96 (0.90–1.00). The NPV (but not PPV) of NEWS2 monitoring exceeded that of other early warning scores including the Modified Early Warning Score (MEWS) (0.59 [0.52–0.66], p<0.001) and quick Sepsis Related Organ Failure Assessment (qSOFA) score (0.58 [0.51–0.65], p<0.001).

Conclusion Our results support the use of NEWS2 monitoring as a sensitive method to identify deterioration of hospitalised COVID-19 patients, albeit at the expense of a relatively high false-trigger rate.

KEYWORDS
  • early warning score
  • COVID-19
  • SARS-CoV-2
  • deterioration
  • monitoring
  • © Royal College of Physicians 2021. All rights reserved.
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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 Feb 2021, clinmed.2020-0688; 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 Feb 2021, clinmed.2020-0688; DOI: 10.7861/clinmed.2020-0688
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