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Maves, Ryan C; Richard, Stephanie A; Lindholm, David A; Epsi, Nusrat; Larson, Derek T; Conlon, Christian; Everson, Kyle; Lis, Steffen; Blair, Paul W; Chi, Sharon; Ganesan, Anuradha; Pollett, Simon; Burgess, Timothy H; Agan, Brian K; Colombo, Rhonda E; Colombo, Christopher J; Cowden, J; Lindholm, D; Markelz, A; Mende, K; Merritt, S; Merritt, T; Walter, R; Wellington, T; [...]

Predictive Value of an Age-Based Modification of the National Early Warning System in Hospitalized Patients With COVID-19

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  • Media type: E-Article
  • Title: Predictive Value of an Age-Based Modification of the National Early Warning System in Hospitalized Patients With COVID-19
  • Contributor: Maves, Ryan C; Richard, Stephanie A; Lindholm, David A; Epsi, Nusrat; Larson, Derek T; Conlon, Christian; Everson, Kyle; Lis, Steffen; Blair, Paul W; Chi, Sharon; Ganesan, Anuradha; Pollett, Simon; Burgess, Timothy H; Agan, Brian K; Colombo, Rhonda E; Colombo, Christopher J; Cowden, J; Lindholm, D; Markelz, A; Mende, K; Merritt, S; Merritt, T; Walter, R; Wellington, T; [...]
  • imprint: Oxford University Press (OUP), 2021
  • Published in: Open Forum Infectious Diseases
  • Language: English
  • DOI: 10.1093/ofid/ofab421
  • ISSN: 2328-8957
  • Origination:
  • Footnote:
  • Description: <jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Early recognition of high-risk patients with coronavirus disease 2019 (COVID-19) may improve outcomes. Although many predictive scoring systems exist, their complexity may limit utility in COVID-19. We assessed the prognostic performance of the National Early Warning Score (NEWS) and an age-based modification (NEWS+age) among hospitalized COVID-19 patients enrolled in a prospective, multicenter US Military Health System (MHS) observational cohort study.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Hospitalized adults with confirmed COVID-19 not requiring invasive mechanical ventilation at admission and with a baseline NEWS were included. We analyzed each scoring system’s ability to predict key clinical outcomes, including progression to invasive ventilation or death, stratified by baseline severity (low [0–3], medium [4–6], and high [≥7]).</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Among 184 included participants, those with low baseline NEWS had significantly shorter hospitalizations (P &amp;lt; .01) and lower maximum illness severity (P &amp;lt; .001). Most (80.2%) of low NEWS vs 15.8% of high NEWS participants required no or at most low-flow oxygen supplementation. Low NEWS (≤3) had a negative predictive value of 97.2% for progression to invasive ventilation or death; a high NEWS (≥7) had high specificity (93.1%) but low positive predictive value (42.1%) for such progression. NEWS+age performed similarly to NEWS at predicting invasive ventilation or death (NEWS+age: area under the receiver operating characteristics curve [AUROC], 0.69; 95% CI, 0.65–0.73; NEWS: AUROC, 0.70; 95% CI, 0.66–0.75).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>NEWS and NEWS+age showed similar test characteristics in an MHS COVID-19 cohort. Notably, low baseline scores had an excellent negative predictive value. Given their easy applicability, these scoring systems may be useful in resource-limited settings to identify COVID-19 patients who are unlikely to progress to critical illness.</jats:p> </jats:sec>
  • Access State: Open Access