The ROX index has greater predictive validity than NEWS2 for deterioration in Covid-19
| Autor: | Guy Glover, Emma J Prower, Cormac Breen, Maja Gavrilovski, Abdel Douiri, Alessandra Bisquera, Megan Pontin, David Grant, Luigi Camporota |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Predictive validity
Medicine (General) medicine.medical_specialty Respiratory rate Disease NEWS2 01 natural sciences Article 03 medical and health sciences R5-920 0302 clinical medicine Internal medicine medicine 030212 general & internal medicine 0101 mathematics Adverse effect Receiver operating characteristic business.industry 010102 general mathematics Retrospective cohort study General Medicine Predicting deterioration Early warning score Coronavirus Rapid response systems Respiratory failure ROX business Covid-19 |
| Zdroj: | EClinicalMedicine EClinicalMedicine, Vol 35, Iss, Pp 100828-(2021) |
| ISSN: | 2589-5370 |
| Popis: | Background Patients admitted to hospital with Covid-19 are at risk of deterioration. The National Early Warning Score (NEWS2) is widely recommended, however it's validity in Covid-19 is not established and indices more specific for respiratory failure may be more appropriate. We aim to describe the physiological antecedents to deterioration, test the predictive validity of NEWS2 and compare this to the ROX index ([SpO2/FiO2]/respiratory rate). Method A single centre retrospective cohort study of adult patients who were admitted to a medical ward, between 1/3/20 and 30/5/20, with positive results for SARS-CoV-2 RNA. Physiological observations and the NEWS2 were extracted and analysed. The primary outcome was a composite of cardiac arrest, unplanned critical care admission or death within 24 hours. A generalized linear model was used to assess the association of physiological values, NEWS2 and ROX with the outcome. Findings The primary outcome occurred in 186 patients (26%). In the preceding 24 hours, deterioration was most marked in respiratory parameters, specifically in escalating oxygen requirement; tachypnoea was a late sign, whilst cardiovascular observations remained stable. The area under the receiver operating curve was 0.815 (95% CI 0.804–0.826) for NEWS2 and 0.848 (95% CI 0.837–0.858) for ROX. Applying the optimal level of ROX, the majority of patients triggered four hours earlier than with NEWS2 of 5. Interpretation NEWS2 may under-perform in Covid-19 due to intrinsic limitations of the design and the unique pathophysiology of the disease. A simple index utilising respiratory parameters can outperform NEWS2 in predicting the occurrence of adverse events. |
| Databáze: | OpenAIRE |
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