Can the prehospital National Early Warning Score 2 identify patients at risk of in-hospital early mortality? A prospective, multicenter cohort study

Martin-Rodríguez, Francisco; López-Izquierdo, Raúl; Vegas, Carlos Del Pozo; Sánchez-Soberón, Irene; Delgado-Benito, Juan F.; Conty, José Luis Martín; Villamor, Miguel Ángel Castro

doi:10.1016/j.hrtlng.2020.02.047

Cited by 23 publications

(27 citation statements)

References 34 publications

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“…16 is based on a hospital assessed cohort -QCovid36 does not incorporate acute variables so will underestimate severity in sick patients who lack known risk factors -NEWS237 is not covid-19 specific and the score may change only at a late stage of deterioration…”

mentioning

confidence: 99%

Remote management of covid-19 using home pulse oximetry and virtual ward support

Greenhalgh

Knight

Inda-Kim

et al. 2021

BMJ

129

139

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mentioning

confidence: 99%

Remote management of covid-19 using home pulse oximetry and virtual ward support

Greenhalgh

Knight

Inda-Kim

et al. 2021

BMJ

129

139

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“…To standardize initial and serial assessments of patients' clinical status, the NEWS2 scale (the latest version of the National Early Warning Score) was used. NEWS2 scores were based on assessment of six physiological indices: respiratory rate; oxygen saturation; systolic blood pressure; heart rate; level of consciousness; and temperature [ 8 , 9 ].…”

Section: Methodsmentioning

confidence: 99%

Temporal Clinical and Laboratory Response to Interleukin-6 Receptor Blockade With Tocilizumab in 89 Hospitalized Patients With COVID-19 Pneumonia

Fomina

Лысенко

Beloglazova

et al. 2020

PAI

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Background: Pandemic COVID-19 pneumonia due to SARS-2 is an important cause of morbidity and mortality. Emerging evidence links poor outcomes to an inflammatory cytokine storm.Methods: We treated 89 hospitalized patients with COVID-19 pneumonia and heightened systemic inflammation (elevated serum C reactive protein and interleukin-6 levels) with an infusion of tocilizumab (TCZ), a human monoclonal IgG1 antibody to the interleukin-6 receptor.Results: Clinical and laboratory evidence of improvement was evident when baseline and 1-2-day post-infusion indices were compared. Among the 72 patients receiving supplemental oxygen without mechanical ventilation, severity of condition on the NEWS2 scale scores fell from 5 to 2 (P<0.001), C reactive protein levels fell from 95 to 14 mg/L (P<0.001), and lymphocyte counts rose from 900 to 1000/uL (P=0.036). Sixty-three of 72 patients were discharged from the hospital, one patient died, and eight patients remained in the hospital at the time of this writing. Among the 17 patients receiving mechanical ventilation, despite a rapid decrease in CRP levels from 89 to 35 mg/L (P=0.014) and early improvements in NEWS2 scores in 10 of 17 patients, 10 patients ultimately died and the other seven remain in the hospital at the time of this writing. Overall, mortality was only seen in patients who had markedly elevated CRP levels (>30 mg/L) and low lymphocyte counts (<1000/uL) before TCZ administration.Conclusions: Inflammation and lymphocytopenia are linked to mortality in COVID-19. Inhibition of IL-6 activity by administration of tocilizumab, an anti-IL-6 receptor antibody, is associated with rapid improvement in both CRP and lymphocyte counts and in clinical indices. Controlled clinical trials are needed to confirm the utility of IL-6 blockade in this setting. Additional interventions will be needed for patients requiring mechanical ventilation.

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“…The NEWS assigns a score to f R values outside of the 12-20 breaths/min range, with the highest score attributed to f R values ≤8 and ≥25 breaths/min [112], while the highest score for MEWS is attributed to f R values ≥30 breaths/min [113]. A modified version of NEWS (i.e., NEWS2) has shown a good predictive capacity for the identification of in-hospital early mortality (all-cause) even when vital signs were collected at pre-hospital level, with f R showing lower values in survivors compared to non-survivors [114]. f R is also among the signs used for sepsis identification [115][116][117].…”

Section: Current Evidencementioning

confidence: 99%

The Importance of Respiratory Rate Monitoring: From Healthcare to Sport and Exercise

Nicolò

Massaroni

Schena

et al. 2020

Sensors

193

137

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Respiratory rate is a fundamental vital sign that is sensitive to different pathological conditions (e.g., adverse cardiac events, pneumonia, and clinical deterioration) and stressors, including emotional stress, cognitive load, heat, cold, physical effort, and exercise-induced fatigue. The sensitivity of respiratory rate to these conditions is superior compared to that of most of the other vital signs, and the abundance of suitable technological solutions measuring respiratory rate has important implications for healthcare, occupational settings, and sport. However, respiratory rate is still too often not routinely monitored in these fields of use. This review presents a multidisciplinary approach to respiratory monitoring, with the aim to improve the development and efficacy of respiratory monitoring services. We have identified thirteen monitoring goals where the use of the respiratory rate is invaluable, and for each of them we have described suitable sensors and techniques to monitor respiratory rate in specific measurement scenarios. We have also provided a physiological rationale corroborating the importance of respiratory rate monitoring and an original multidisciplinary framework for the development of respiratory monitoring services. This review is expected to advance the field of respiratory monitoring and favor synergies between different disciplines to accomplish this goal.

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Can the prehospital National Early Warning Score 2 identify patients at risk of in-hospital early mortality? A prospective, multicenter cohort study

Cited by 23 publications

References 34 publications

Remote management of covid-19 using home pulse oximetry and virtual ward support

Remote management of covid-19 using home pulse oximetry and virtual ward support

Temporal Clinical and Laboratory Response to Interleukin-6 Receptor Blockade With Tocilizumab in 89 Hospitalized Patients With COVID-19 Pneumonia

The Importance of Respiratory Rate Monitoring: From Healthcare to Sport and Exercise

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