Evaluation of a Modified Early Warning Score (MEWS) adjusted for COVID-19 patients (CEWS) to identify risk of ICU admission or death

  1. Linda Smid
  2. Lano Osman
  3. Sandra M. Arend
  4. Stefanie de Groot
  5. Mark G.J. de Boer

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Abstract

The commonly used Modified Early Warning score (MEWS) may poorly predict deterioration in COVID-19 patients. Therefore, an adjusted MEWS for COVID-19 patients (CEWS) was constructed. CEWS exceeded MEWS at all time points and impending death or intensive care unit (ICU) admission was strongly correlated with a persistently high CEWS.

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  1. ScreenIT

    SciScore for 10.1101/2020.10.22.20217539: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: This study was approved by the Institutional Review Board of the LUMC for observational studies.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    The data was analyzed using Statistical Package for Social Sciences (SPSS) software™ 23.0 (IBM Corp., Armonk, NY, USA).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    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:
    A limitation of our study is the modest sample size. In addition, information bias could have played a role since vital parameters are measured more often in seriously ill patients. As a result, a more accurate course of the MEWS and CEWS can be expected in case patients as compared to less ill control patients. Based on our results, a persistently elevated early warning score, in particular CEWS, indicates a high risk of an upcoming life-threatening event. The difference between the CEWS in cases versus controls exceeded the difference in the MEWS, and seems to be a more reliable warning score of the need for ICU admission or mortality. Further prospective studies are needed to validate the predictive value of a persistently high MEWS or CEWS in patients with a COVID-19 infection.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).

    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

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.10.22.20217539v1 on medRxiv