National Early Warning Score 2 (NEWS2) to identify inpatient COVID-19 deterioration: a retrospective analysis
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.
- © Royal College of Physicians 2021. All rights reserved.
Article Tools
Citation Manager Formats
Jump to section
Related Articles
- No related articles found.
Cited By...
- The National Early Warning Score: from concept to NHS implementation
- Evaluation of the utility of NEWS2 during the COVID-19 pandemic
- Prognostic value of National Early Warning Scores (NEWS2) and component physiology in hospitalised patients with COVID-19: a multicentre study
- National Early Warning Score 2 (NEWS2) to identify inpatient COVID-19 deterioration: The importance of pO2:FiO2 ratio
- Assisting clinical decision making: tools, rules and teams