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

• Published in: Open forum infectious diseases Vol. 8; no. 12; p. ofab421
• Main Authors: 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
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 01.12.2021
• Subjects: Major; COVID-19; early warning score; prognosis
• ISSN: 2328-8957; 2328-8957
• DOI: 10.1093/ofid/ofab421

Abstract Background 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. Methods 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]). Results Among 184 included participants, those with low baseline NEWS had significantly shorter hospitalizations (P < .01) and lower maximum illness severity (P < .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). Conclusions 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.