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Predictive Value of an Age-Based Modification of the National Early Warning System in Hospitalized Patients With
Ryan C Maves1,2,3, Stephanie A Richard1,4, David A Lindholm5,6
1Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
Insights
The National Early Warning Score (NEWS) and NEWS+age effectively identify hospitalized COVID-19 patients unlikely to progress. Low NEWS scores accurately predict minimal need for oxygen or ventilation, aiding resource allocation.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Health Systems Research
Background:
- Early identification of high-risk coronavirus disease 2019 (COVID-19) patients is crucial for improved outcomes.
- Existing predictive scoring systems may be too complex for widespread use in COVID-19 management.
- The prognostic performance of the National Early Warning Score (NEWS) and its age-adjusted variant (NEWS+age) was evaluated in hospitalized COVID-19 patients.
Purpose of the Study:
- To assess the prognostic accuracy of NEWS and NEWS+age in predicting clinical outcomes for hospitalized COVID-19 patients.
- To determine the utility of these scores in stratifying patients based on baseline severity.
- To evaluate the potential use of these scores in resource-limited settings.
Main Methods:
- A prospective, multicenter observational cohort study of hospitalized adults with confirmed COVID-19 was conducted.
- Patients not requiring invasive mechanical ventilation at admission were included.
- The ability of NEWS and NEWS+age to predict progression to invasive ventilation or death was analyzed, stratified by baseline severity (low, medium, high).
Main Results:
- Low baseline NEWS scores were associated with significantly shorter hospitalizations and lower maximum illness severity.
- 80.2% of patients with low NEWS required no or low-flow oxygen, compared to 15.8% with high NEWS.
- Low NEWS (≤3) demonstrated a 97.2% negative predictive value for progression to invasive ventilation or death; high NEWS (≥7) showed high specificity (93.1%) but low positive predictive value (42.1%). NEWS+age performance was similar to NEWS.
Conclusions:
- NEWS and NEWS+age exhibited comparable prognostic performance in this US Military Health System COVID-19 cohort.
- Low baseline NEWS scores possess excellent negative predictive value, identifying patients unlikely to experience critical illness.
- The simplicity and applicability of NEWS and NEWS+age suggest their utility in resource-limited settings for risk stratification of COVID-19 patients.
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.
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