National Early Warning Scores and COVID-19 deaths in care homes: a longitudinal ecological study

  1. Daniel Stow
  2. Robert O Barker
  3. Fiona E Matthews
  4. Barbara Hanratty

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Abstract

Objectives

To investigate whether patterns of National Early Warning Scores (NEWS/NEWS2) in care homes during the COVID pandemic correspond with area-level COVID-19 death registrations from care homes.

Study design

Longitudinal ecological study.

Setting

460 Care home units using the same software package to collect data on residents, from 46 local authority areas in England.

Participants

6,464 care home residents with at least one NEWS recording.

Exposure measure

29,656 anonymised person-level NEWS from 29/12/2019 to 20/05/2020 with component physiological measures: systolic blood pressure, respiratory rate, pulse rate, temperature, and oxygen saturation. Baseline values for each measure calculated using 80 th and 20 th centile scores before March 2020.

Outcome measure

Time series comparison with Office for National Statistics (ONS) weekly reported registered deaths of care home residents where COVID-19 was the underlying cause of death, and all other deaths (excluding COVID-19) up to 10/05/2020.

Results

Deaths due to COVID-19 were registered from 23/03/2020 in the study geographical areas. Between 23/03/2020 and 10/05/2020, there were 5,753 deaths (1,532 involving COVID-19 and 4,221 other causes). The proportion of above-baseline NEWS increased from 16/03/2020 and closely followed the rise and fall in COVID-19 deaths over the study period. The proportion of above-baseline oxygen saturation, respiratory rate and temperature measurements also increased approximately two weeks before peaks in care home deaths in corresponding geographical areas.

Conclusions

NEWS may make a useful contribution to disease surveillance in care homes during the COVID-19 pandemic. Oxygen saturation, respiratory rate and temperature could be prioritised as they appear to signal rise in mortality almost as well as total NEWS. This study reinforces the need to collate data from care homes, to monitor and protect residents’ health. Further work using individual level outcome data is needed to evaluate the role of NEWS in the early detection of resident illness.

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  1. ScreenIT

    SciScore for 10.1101/2020.06.15.20131516: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and limitations: To our knowledge, this is the first study to examine longitudinal variation in NEWS in care homes. We have described trends over time using a specific software system to collect data on NEWS in care homes. This means that the distribution of care homes within and between areas is not systematic, as it reflects the market share of the software company and local support for digital data collection in care homes. Most recordings were drawn from the north east of England, and a London borough, but we have no information on the proportion of care home residents in each area that are represented in our dataset. All the data were anonymised, and without individual outcome data, we examined patterns in and simple correlations between NEWS and area-level weekly registered death information. This study design was a pragmatic approach that made best use of available data, but it is not a causal study, nor a study of diagnostic accuracy, and it is liable to the ecological fallacy.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1101/2020.06.15.20131516v1 on medRxiv