Comorbidity‐adjusted NEWS predicts mortality in suspected patients with COVID‐19 from nursing homes: Multicentre retrospective cohort study

Abstract

Aims To assess the prognostic accuracy of comorbidity‐adjusted National Early Warning Score in suspected Coronavirus disease 2019 patients transferred from nursing homes by the Emergency Department. Design Multicentre retrospective cohort study. Methods Patients transferred by high‐priority ambulances from nursing homes to Emergency Departments with suspected severe acute respiratory syndrome coronavirus 2 infection, from March 12 to July 31 2020, were considered. Included variables were: clinical covariates (respiratory rate, oxygen saturation, systolic blood pressure, heart rate, temperature, level of consciousness and supplemental oxygen use), the presence of comorbidities and confirmatory analytical diagnosis of severe acute respiratory syndrome coronavirus 2 infection. The primary outcome was a 2‐day mortality rate. The discriminatory capability of the National Early Warning Score was assessed by the area under the receiver operating characteristic curve in two different cohorts, the validation and the revalidation, which were randomly selected from the main cohort. Results A total of 337 nursing homes, 10 advanced life support units, 51 basic life support units and 8 hospitals in Spain entailing 1,324 patients (median age 87 years) was involved in this study. Two‐day mortality was 11.5% (152 cases), with a positivity rate of severe acute respiratory syndrome coronavirus 2 of 51.2%, 77.7% of hospitalization from whom 1% was of intensive care unit admission. The National Early Warning Score results for the revalidation cohort presented an AUC of 0.771, and of 0.885, 0.778 and 0.730 for the low‐, medium‐ and high‐level groups of comorbidities. Conclusion The comorbidity‐adjusted National Early Warning Score provides a good short‐term prognostic criterion, information that can help in the decision‐making process to guide the best strategy for each older adult, under the current pandemic. Impact What problem did the study address? Under the current coronavirus disease 2019 pandemic, targeting older adults at high risk of deterioration in nursing homes remains challenging. What were the main findings? Comorbidity‐adjusted National Early Warning Score helps to forecast the risk of clinical deterioration more accurately. Where and on whom will the research have impact? A high NEWS, with a low level of comorbidity is associated with optimal predictive performance, making these older adults likely to benefit from continued follow up and potentially hospital referral under the current coronavirus disease 2019 pandemic.

Autonomic Dysfunction during Acute SARS-CoV-2 Infection: A Systematic Review

“…After removing duplicates, 1585 results remained and were evaluated for title and abstract check. Therefore, 65 reports were considered in the full-text review stage, and 20 of those were included in the systematic review [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48], while 45 reports were excluded: 2 papers written in Russian [49,50], 5 conference papers [51][52][53][54][55], 3 comments [56][57][58], 4 case reports or case series [59][60][61][62], 2 literature reviews [63,64], 1 study protocol [65], 12 studies that did not perform a formal evaluation of autonomic functions [66][67][68][69][70][71][72][73][74][75]…”

“…Details regarding the selection process are available in the PRISMA diagram (Figure 1). [66][67][68][69][70][71][72][73][74][75][76][77]; not acute COVID-19 population-Refs. [78][79][80][81][82][83][84][85][86][87][88][89][90]; not in English or Italian-Refs.…”

“…The PRISMA diagram of the systematic review. Reports excluded: Not formal assessment of dysautonomia-Refs [66][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84][85][86][87][88][89][90]…”

COVID-19 as a risk factor for long-term mortality in patients managed by the emergency medical system: A prospective, multicenter, ambulance-based cohort study

“…Remarkably, at the start of the outbreak, unacceptable mortality rates associated with nursing homes were observed. Admittedly, patients are multi-pathological, with multiple comorbidities, and generally of elderly age, but the over-mortality described in nursing homes should give us a wake-up call to reconsider this fact as a healthcare system ( 29 , 30 ). Nursing home mortality was two times as high as in the COVID-19 cohort compared to patients managed by EMS due to acute disease without COVID-19; this irrefutable observation flags nursing home affiliation as a critical factor underlying poor long-term outcomes ( 31 ).…”