Modified National Early Warning Score as Early Predictor of Outcome in COVID-19 Pandemic

Abstract

COVID-19 represented an important challenge to the Italian healthcare system (IHCS). Our main aim was to obtain evidence to support the use of modified national early warning score (m-NEWS) as an interdisciplinary, common, and universal scoring scale to quickly recognize patients with a risk of clinical deterioration before admission and during hospitalization. As a secondary goal, we tried to find a score threshold that can trigger patients’ immediate medical review as a part of an optimal triaging protocol for an emergency setting where healthcare resources are overloaded. We performed a retrospective observational study. We included in our study all patients treated for COVID-19 infection in surgical departments between 01 March 2020 and 16 April 2020. Patients with negative test results for SARS-COV-2 were excluded. m-NEWS was obtained twice a day. Patients’ m-NEWS were analyzed in order to verify the correlation between m-NEWS (at admission and m-NEWS variation 24 h after admission) and outcome (positive outcome-survival, negative outcome-death, or intensive care unit (ICU) transfer). We included a population-based sample of 225 SARS-COV-2-infected patients. Overall, the average age at hospitalization was 71 (ranging from 40 to 95). 144 (64%) patients were males and 81 (36%) females. m-NEWS values lower or equal to 7 were associated with the majority of the “recovered” population (100/132 75.75%) and at the same time with the minority of the “non-recovered” population (25/93 26.88%). For our sample, age is statistically correlated to the outcome but a triage protocol based solely on this variable is less effective than m-NEWS, which showed to be a reliable and easy-to-use score for first patient evaluation. Our observations pave the way towards further studies aiming at optimizing territorial and community healthcare management protocols.

Digital Health Literacy About COVID-19 as a Factor Mediating the Association Between the Importance of Online Information Search and Subjective Well-Being Among University Students in Vietnam

“…As there has been widely shared disinformation on the social platforms during the pandemic, DHL of university students is affected when students cannot properly appraise the quality of information on COVID-19 and are manipulated by false information. The overabundance of COVID-19 related information could bring about negative mental health consequences to those who are not able to critically evaluate the information they read (37), as disinformation and fake news could lead to confusion and increased stress (38,39). As the Internet and digital platforms have become the major sources of health information regarding COVID-19, it is important to strengthen the DHL of students.…”

Escala NEWS como predictor de mortalidad en pacientes con COVID-19

“…El 10.2% (11) de los pacientes con clasificación de alto riesgo fallecieron; mientras que perecieron el 6.8% (5) y 4.9% (2) con clasificación de mediano y bajo riesgo respectivamente (Gráfico 2). El 25.9% (28) de los pacientes con puntuación de alto riesgo fue admitido en UCI, por otro lado, el 20.5% (15) riesgo mediano y el 17.1% (7) de riesgo bajo requirieron ingresar a UCI (Gráfico 3). Se realizó la prueba estadística no paramétrica correlación de Spearman, para analizar si existe asociación entre el puntaje obtenido con NEWS y el desenlace del paciente, obteniendo el coeficiente de correlación -0.08 IC 95% [-0.21;0.06] ῤ=0.25, así mismo; se buscó la correlación entre la estratificación de riesgo NEWS con el requerimiento de cuidados intensivos, siendo el coeficiente de correlación 0.08 IC 95% [0.05; 0.22] ῤ=0.21.…”

“…(14) La experiencia en China en el manejo del COVID -19, ha sugerido el uso de una versión modificada de NEWS (m -NEWS), asignando más puntaje cuando mayor es la edad del paciente, como ya se demostró en la literatura, esta es un factor de riesgo para la supervivencia. (15) Desarrollar una estrategia de puntuación ideal para pacientes con COVID -19, probablemente habría sido necesario también evaluar otros elementos epidemiológicos o fisiológicos. Los estudios con poblaciones relativamente pequeñas han obtenido resultados aparentemente controvertidos, el entorno de aplicación como en el contexto de pacientes agudos (emergencia, UCI) las características clínicas que definen mayor puntuación tienen posibles sesgos de medición (ejemplo: frecuencia respiratoria, temperatura, estado mental), las cuales dependen mucho del profesional de salud que realiza la toma de datos o variabilidad con el instrumento utilizado, como termómetros digitales.…”

Prognostic accuracy of early warning scores for predicting serious illness and in-hospital mortality in patients with COVID-19

“…This score already suggested in China for making triage decisions for patients with COVID-19 and we found the nearest cut-off value like them for predicting death [ 25 ]. The retrospective study performed in Alzano Lombardo hospital, Italy, indicated m-NEWS score 7 or greater at admission was associated with a negative outcome, which means patients need more intensive care and treatment, whereas patients who had m-NEWS score on admission under 7 were associated with a higher chance of recovery [ 6 ]. In the case of anticipating serious illness m-NEWS had less cut-off value, which is 4 or more might be the reason for excluding patients who had a serious illness during admission time as we want to prognosticate the patients who will get severe or critical COVID-19 later.…”

“…The increasing number of patients with COVID-19 has created a burden on all tertiary level facilities [ 5 ]. In this complex situation, it became mandatory to develop systematic clinical strategies for efficient use of medical efforts to effectively treat COVID-19 and most importantly, identify a sub-population requiring immediate critical care to reduce fatal consequences [ 5 , 6 ].…”