Evaluation and improvement of the National Early Warning Score (NEWS2) for COVID-19: a multi-hospital study.

Autor: Carr E; Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, London, SE5 8AF, UK. ewan.carr@kcl.ac.uk., Bendayan R; Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.; NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK., Bean D; Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.; Health Data Research UK London, University College London, London, UK., Stammers M; Clinical Informatics Research Unit, University of Southampton, Coxford Rd., Southampton, SO16 5AF, UK.; NIHR Biomedical Research Centre at University Hospital Southampton NHS Trust, Coxford Road, Southampton, UK.; UHS Digital, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, UK., Wang W; School of Population Health and Environmental Sciences, King's College London, London, UK., Zhang H; Usher Institute, University of Edinburgh, Edinburgh, UK., Searle T; Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.; NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK., Kraljevic Z; Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, London, SE5 8AF, UK., Shek A; Department of Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK., Phan HTT; Clinical Informatics Research Unit, University of Southampton, Coxford Rd., Southampton, SO16 5AF, UK.; NIHR Biomedical Research Centre at University Hospital Southampton NHS Trust, Coxford Road, Southampton, UK., Muruet W; School of Population Health and Environmental Sciences, King's College London, London, UK., Gupta RK; UCL Institute for Global Health, University College London Hospitals NHS Trust, London, UK., Shinton AJ; UHS Digital, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, UK., Wyatt M; University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK., Shi T; Usher Institute, University of Edinburgh, Edinburgh, UK., Zhang X; Department of Pulmonary and Critical Care Medicine, People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming, Yunnan, China., Pickles A; Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.; NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK., Stahl D; Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, London, SE5 8AF, UK., Zakeri R; King's College Hospital NHS Foundation Trust, London, UK.; School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, London, SE5 9NU, UK., Noursadeghi M; UCL Division of Infection and Immunity, University College London Hospitals NHS Trust, London, UK., O'Gallagher K; King's College Hospital NHS Foundation Trust, London, UK.; School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, London, SE5 9NU, UK., Rogers M; University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK., Folarin A; Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.; Health Data Research UK London, University College London, London, UK.; Institute of Health Informatics, University College London, London, UK.; NIHR Biomedical Research Centre at University College London Hospitals NHS Foundation Trust, London, UK., Karwath A; College of Medical and Dental Sciences, Institute of Cancer and Genomics, University of Birmingham, Birmingham, UK.; Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.; Health Data Research UK Midlands, Birmingham, UK., Wickstrøm KE; Department of Medical Biochemistry, Blood Cell Research Group, Oslo University Hospital, Oslo, Norway., Köhn-Luque A; Oslo Centre for Biostatistics and Epidemiology, Faculty of Medicine, University of Oslo, Oslo, Norway., Slater L; College of Medical and Dental Sciences, Institute of Cancer and Genomics, University of Birmingham, Birmingham, UK.; Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.; Health Data Research UK Midlands, Birmingham, UK., Cardoso VR; College of Medical and Dental Sciences, Institute of Cancer and Genomics, University of Birmingham, Birmingham, UK.; Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.; Health Data Research UK Midlands, Birmingham, UK., Bourdeaux C; University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK., Holten AR; Department of Acute Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway., Ball S; Health Data Research UK Midlands, Birmingham, UK.; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., McWilliams C; Department of Engineering Mathematics, University of Bristol, Bristol, UK., Roguski L; Health Data Research UK London, University College London, London, UK.; Institute of Health Informatics, University College London, London, UK.; Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., Borca F; Clinical Informatics Research Unit, University of Southampton, Coxford Rd., Southampton, SO16 5AF, UK.; NIHR Biomedical Research Centre at University Hospital Southampton NHS Trust, Coxford Road, Southampton, UK.; UHS Digital, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, UK., Batchelor J; Clinical Informatics Research Unit, University of Southampton, Coxford Rd., Southampton, SO16 5AF, UK., Amundsen EK; Department of Medical Biochemistry, Blood Cell Research Group, Oslo University Hospital, Oslo, Norway., Wu X; Department of Pulmonary and Critical Care Medicine, Shanghai East Hospital, Tongji University, Shanghai, China.; Department of Pulmonary and Critical Care Medicine, Taikang Tongji Hospital, Wuhan, China., Gkoutos GV; College of Medical and Dental Sciences, Institute of Cancer and Genomics, University of Birmingham, Birmingham, UK.; Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.; Health Data Research UK Midlands, Birmingham, UK.; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., Sun J; Department of Pulmonary and Critical Care Medicine, Shanghai East Hospital, Tongji University, Shanghai, China., Pinto A; UHS Digital, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, UK., Guthrie B; Usher Institute, University of Edinburgh, Edinburgh, UK., Breen C; School of Population Health and Environmental Sciences, King's College London, London, UK., Douiri A; School of Population Health and Environmental Sciences, King's College London, London, UK., Wu H; Health Data Research UK London, University College London, London, UK.; Institute of Health Informatics, University College London, London, UK., Curcin V; School of Population Health and Environmental Sciences, King's College London, London, UK., Teo JT; Department of Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.; King's College Hospital NHS Foundation Trust, London, UK., Shah AM; King's College Hospital NHS Foundation Trust, London, UK.; School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, London, SE5 9NU, UK., Dobson RJB; Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.; NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK.; Health Data Research UK London, University College London, London, UK.; Institute of Health Informatics, University College London, London, UK.; NIHR Biomedical Research Centre at University College London Hospitals NHS Foundation Trust, London, UK.
Jazyk: angličtina
Zdroj: BMC medicine [BMC Med] 2021 Jan 21; Vol. 19 (1), pp. 23. Date of Electronic Publication: 2021 Jan 21.
DOI: 10.1186/s12916-020-01893-3
Abstrakt: Background: The National Early Warning Score (NEWS2) is currently recommended in the UK for the risk stratification of COVID-19 patients, but little is known about its ability to detect severe cases. We aimed to evaluate NEWS2 for the prediction of severe COVID-19 outcome and identify and validate a set of blood and physiological parameters routinely collected at hospital admission to improve upon the use of NEWS2 alone for medium-term risk stratification.
Methods: Training cohorts comprised 1276 patients admitted to King's College Hospital National Health Service (NHS) Foundation Trust with COVID-19 disease from 1 March to 30 April 2020. External validation cohorts included 6237 patients from five UK NHS Trusts (Guy's and St Thomas' Hospitals, University Hospitals Southampton, University Hospitals Bristol and Weston NHS Foundation Trust, University College London Hospitals, University Hospitals Birmingham), one hospital in Norway (Oslo University Hospital), and two hospitals in Wuhan, China (Wuhan Sixth Hospital and Taikang Tongji Hospital). The outcome was severe COVID-19 disease (transfer to intensive care unit (ICU) or death) at 14 days after hospital admission. Age, physiological measures, blood biomarkers, sex, ethnicity, and comorbidities (hypertension, diabetes, cardiovascular, respiratory and kidney diseases) measured at hospital admission were considered in the models.
Results: A baseline model of 'NEWS2 + age' had poor-to-moderate discrimination for severe COVID-19 infection at 14 days (area under receiver operating characteristic curve (AUC) in training cohort = 0.700, 95% confidence interval (CI) 0.680, 0.722; Brier score = 0.192, 95% CI 0.186, 0.197). A supplemented model adding eight routinely collected blood and physiological parameters (supplemental oxygen flow rate, urea, age, oxygen saturation, C-reactive protein, estimated glomerular filtration rate, neutrophil count, neutrophil/lymphocyte ratio) improved discrimination (AUC = 0.735; 95% CI 0.715, 0.757), and these improvements were replicated across seven UK and non-UK sites. However, there was evidence of miscalibration with the model tending to underestimate risks in most sites.
Conclusions: NEWS2 score had poor-to-moderate discrimination for medium-term COVID-19 outcome which raises questions about its use as a screening tool at hospital admission. Risk stratification was improved by including readily available blood and physiological parameters measured at hospital admission, but there was evidence of miscalibration in external sites. This highlights the need for a better understanding of the use of early warning scores for COVID.
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje