The performance of the National Early Warning Score and National Early Warning Score 2 in hospitalised patients infected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

Abstract

Introduction Since the introduction of the UK’s National Early Warning Score (NEWS) and its modification, NEWS2, Coronavirus disease 2019 (COVID-19), has caused a worldwide pandemic. NEWS and NEWS2 have good predictive abilities in patients with other infections and sepsis, however there is little evidence of their performance in COVID-19. Methods Using receiver-operating characteristics analyses, we used the area under the receiver operating characteristic (AUROC) curve to evaluate the performance of NEWS or NEWS2 to discriminate the combined outcome of either death or intensive care unit (ICU) admission within 24 h of a vital sign set in five cohorts (COVID-19 POSITIVE, n = 405; COVID-19 NOT DETECTED, n = 1716; COVID-19 NOT TESTED, n = 2686; CONTROL 2018, n = 6273; CONTROL 2019, n = 6523). Results The AUROC values for NEWS or NEWS2 for the combined outcome were: COVID-19 POSITIVE, 0.882 (0.868−0.895); COVID-19 NOT DETECTED, 0.875 (0.861−0.89); COVID-19 NOT TESTED, 0.876 (0.85−0.902); CONTROL 2018, 0.894 (0.884−0.904); CONTROL 2019, 0.842 (0.829−0.855). Conclusions The finding that NEWS or NEWS2 performance was good and similar in all five cohorts (range = 0.842−0.894) suggests that amendments to NEWS or NEWS2, such as the addition of new covariates or the need to change the weighting of existing parameters, are unnecessary when evaluating patients with COVID-19. Our results support the national and international recommendations for the use of NEWS or NEWS2 for the assessment of acute-illness severity in patients with COVID-19.

Use of the first National Early Warning Score recorded within 24 hours of admission to estimate the risk of in-hospital mortality in unplanned COVID-19 patients: a retrospective cohort study

“…A recent paper by Kostakis et al 7 found good discrimination for NEWS or NEWS2 (c-statistics 0.842–0.894) concluding that their results ‘support the national and international recommendations for the use of NEWS or NEWS2 for the assessment of acute-illness severity in patients with COVID-19.’ In contrast to our approach, Kostakis et al 7 used the last or ultimate recorded NEWS2/NEWS within 24 hours of death or ICU admission. We note that when we consider death within 24 hours of admission, our reported c-statistics for index NEWS/NEWS2 are comparable with those of Kostakis et al .…”

“…We note that when we consider death within 24 hours of admission, our reported c-statistics for index NEWS/NEWS2 are comparable with those of Kostakis et al . 7 …”

“…Nevertheless, it is worth noting that a recent, although small Italian study based on 71 hospitalised COVID-19 patients found NEWS2 to be a good predictor (with a high c-statistic 0.90) of subsequent ICU admission for COVID-19 patients but was not able to consider mortality because of insufficient events. 6 Our study did not consider ICU admissions as an outcome because the number of ICU admissions were low but Kostakis et al 7 used it as a composite outcome with in-hospital mortality. 5…”

“…Gidari et al 6 evaluated NEWS2 at hospital admission of patients with COVID-19 as a predictor of intensive care unit (ICU) admission. Furthermore, Kostakis et al 7 investigated association of the last or ultimate recorded NEWS2/NEWS within 24 hours of death or ICU admission in COVID-19 and non-COVID cohorts.…”

Finally good NEWS: Something simple is working in COVID-19!

“…In this issue, Kostakis et al validate the use of the NEWS score in COVID patients using a Receiver Operator Characteristic (or ROC) curve, with the number of false positives plotted on the x axis and the number of true positives on the y axis 10 . The higher the arc of the curve, the greater the area under the curve (AUROC) and the closer the test gets to a perfect result – represented by a value of 1.…”