TY - JOUR
AU - Carr, Ewan
AU - Bendayan, Rebecca
AU - Bean, Daniel
AU - Stammers, Matt
AU - Wang, Wenjuan
AU - Zhang, Huayu
AU - Searle, Thomas
AU - Kraljevic, Zeljko
AU - Shek, Anthony
AU - Phan, Hang TT
AU - London, Kings
AU - Gupta, Rishi K.
AU - Shinton, Anthony J
AU - Wyatt, Mike
AU - Shi, Ting
AU - Zhang, Xin
AU - Pickles, Andrew
AU - Stahl, Daniel
AU - Zakeri, Rosita
AU - Noursadeghi, Mahdad
AU - O'Gallagher, Kevin
AU - Rogers, Matt
AU - Folarin, Amos
AU - Karwath, Andreas
AU - Wickstrom, Kristin E
AU - Kohn-Luque, Alvaro
AU - Slater, Luke
AU - Cardoso, Victor Roth
AU - Bourdeaux, Christopher
AU - Holten, Aleksander Rygh
AU - Ball, Simon
AU - McWilliams, Chris
AU - Roguski, Lukasz
AU - Borca, Florina
AU - Bachelor, James
AU - Amundsen, Erik Koldberg
AU - Wu, Xiaodong
AU - Gkoutos, Georgios V.
AU - Sun, Jiaxing
AU - Pinto, Ashwin
AU - Guthrie, Bruce
AU - Breen, Cormac
AU - Douiri, Abdel
AU - Wu, Houghan
AU - Curcin, Vasa
AU - Teo, James T
AU - M Shah, Ajay
AU - Dodson, Richard J B
PY - 2021
DA - January
TI - Evaluation and Improvement of the National Early Warning Score (NEWS2) for COVID-19: a multi-hospital study
JO - BMC Medicine
VL - 19
DO - https://doi.org/10.1186/s12916-020-01893-3
AB - Background The National Early Warning Score (NEWS2) is currently recommended in the United Kingdom for risk-stratification of COVID patients, but little is known about its ability to detect severe cases. We aimed to evaluate NEWS2 for prediction of severe COVID outcome and identify and validate a set of blood and physiological parameters routinely-collected at hospital admission to improve upon use of NEWS2 alone for medium-term risk stratification. Methods Training cohorts comprised 1276 patients admitted to King’s College Hospital NHS Foundation Trust with COVID-19 disease from 1st March to 30th April 2020. External validation cohorts included 6237 patients from five UK NHS Trusts (Guys and St Thomas’ Hospitals, University Hospitals Southampton, University Hospitals Bristol and Weston NHS Foundation Trust, University College London Hospitals, University Hospitals Birmingham), one hospital in Norway (Oslo University Hospital), and two hospitals in Wuhan, China (Wuhan Sixth Hospital and Taikang Tongji Hospital). The outcome was severe COVID disease (transfer to intensive care unit or death) at 14 days after hospital admission. Age, physiological measures, blood biomarkers, sex, ethnicity and comorbidities (hypertension, diabetes, cardiovascular, respiratory and kidney diseases) measured at hospital admission were considered in the models. Results A baseline model of ‘NEWS2 + age’ had poor-to-moderate discrimination for severe COVID infection at 14 days (area under receiver operating characteristic curve (AUC) in training cohort = 0.700; 95% CI: 0.680, 0.722; Brier score = 0.192; 95% CI: 0.186, 0.197). A supplemented model adding eight routinely-collected blood and physiological parameters (supplemental oxygen flow rate, urea, age, oxygen saturation, CRP, estimated GFR, neutrophil count, neutrophil/lymphocyte ratio) improved discrimination (AUC = 0.735; 95% CI: 0.715, 0.757) and these improvements were replicated across seven UK and non-UK sites. However, there was evidence of miscalibration with the model tending to underestimate risks in most sites. Conclusions NEWS2 score had poor-to-moderate discrimination for medium-term COVID outcome which raises questions about its use as a screening tool at hospital admission. Risk stratification was improved by including readily available blood and physiological parameters measured at hospital admission, but there was evidence of miscalibration in external sites. This highlights the need for a better understanding of the use of early warning scores for COVID.
PB - Springer Nature
UR - https://www.research.ed.ac.uk/portal/en/publications/evaluation-and-improvement-of-the-national-early-warning-score-news2-for-covid19(07003bf8-bb78-483f-8fa7-3f26b0cb86e3).html
KW - Coronavirus (COVID-19)
KW - Hospital care
ER