TY - JOUR
T1 - Predictive Value of an Age-Based Modification of the National Early Warning System in Hospitalized Patients with COVID-19
AU - EPICC COVID-19 Cohort Study Group
AU - Maves, Ryan C.
AU - Richard, Stephanie A.
AU - Lindholm, David A.
AU - Epsi, Nusrat
AU - Larson, Derek T.
AU - Conlon, Christian
AU - Everson, Kyle
AU - Lis, Steffen
AU - Blair, Paul W.
AU - Chi, Sharon
AU - Ganesan, Anuradha
AU - Pollett, Simon
AU - Burgess, Timothy H.
AU - Agan, Brian K.
AU - Colombo, Rhonda E.
AU - Colombo, Christopher J.
AU - Cowden, J.
AU - Markelz, A.
AU - Mende, K.
AU - Merritt, S.
AU - Merritt, T.
AU - Walter, R.
AU - Wellington, T.
AU - Bazan, S.
AU - Michel, S.
AU - Brandon, L.
AU - Ewers, E.
AU - Gallagher, K.
AU - Larson, D.
AU - Odom, M.
AU - Colombo, C.
AU - Colombo, R.
AU - Conlon, C.
AU - Everson, K.
AU - Faestel, P.
AU - Ferguson, T.
AU - Gordon, L.
AU - Grogan, S.
AU - Lis, S.
AU - Martin, M.
AU - Mount, C.
AU - Musfeldt, D.
AU - Odineal, D.
AU - Robb-Mcgrath, W.
AU - Sainato, R.
AU - Schofield, C.
AU - Skinner, C.
AU - Stein, M.
AU - Switzer, M.
AU - O'Connor, K.
N1 - Publisher Copyright:
© 2021 Published by Oxford University Press on behalf of Infectious Diseases Society of America 2021.
PY - 2021/12/1
Y1 - 2021/12/1
N2 - 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.
AB - 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.
KW - COVID-19
KW - Early warning score
KW - Prognosis
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U2 - 10.1093/ofid/ofab421
DO - 10.1093/ofid/ofab421
M3 - Article
AN - SCOPUS:85122384877
SN - 2328-8957
VL - 8
JO - Open Forum Infectious Diseases
JF - Open Forum Infectious Diseases
IS - 12
M1 - ofab421
ER -
