NEWS-2 Score Assessment of Inpatient Referral during the COVID 19 Epidemic

  1. Valérie Faure
  2. Marc Souris
  3. Arnaud Wilmet
  4. Franck Baudino
  5. Albert Brizo
  6. Christophe Malhaire
  7. François-Xavier Peccaud
  8. Jean-Paul Gonzalez

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Abstract

Aim

To manage patients with suspected coronavirus disease (COVID-19) when they arrive at the hospital emergency department (ED), a clinical severity score is required to quickly identify patients requiring immediate hospital admission and close monitoring. The aim of this study was to evaluate, within the context of the pandemic, the performance of National Early Warning Score 2 (NEWS-2) to anticipate the admission of patients with suspected COVID-19 to a specialised emergency care unit.

Methods

This retrospective study was conducted on patients presenting at the COVID-19 entrance of the ED of the Vert-Galant private hospital (Paris, France) during the first national pandemic peak from March 20 to April 20, 2020. All patients completed a questionnaire and clinical data and vital signs were recorded. Statistical analysis and modelling were used to estimate the ability of different scores (NEWS-2, qSOFA, CRB-65) to predict hospital emergency admission and/or early COVID-19 diagnosis.

Results

NEWS-2, with a cut off value of 5, predicted hospital admission with 82% sensitivity, 98% specificity and an area under the curve (AUC) of 96%. NEWS-2 was superior to qSOFA and CRB-65 scores for predicting hospital admission of COVID-19 patients. Multilinear or logistic regression analysis of clinical data did not improve this result.

Conclusion

NEWS-2 is an excellent score to predict hospital admission of COVID-19 patients.

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    SciScore for 10.1101/2021.06.10.21254528: (What is this?)

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

    Table 1: Rigor

    EthicsConsent: 20 Ethics and data protection: All patients were informed of the data collection by a specific poster in the waiting room and gave their informed consent prior to the recording of vital signs by the TMB.
    IRB: The project, (referenced under the number COS-RGDS-2021-05-001-FAURE-V) has been submitted to the members of the Scientific Committee of the GCS Ramsay Santé for Education and Research.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All statistical calculations were performed with XLSTAT software (version 2020.5.1, Addinsoft) and SavGIS software (version 9.07.015, Institut de Recherche pour le Développement, IRD).
    XLSTAT
    suggested: (XLSTAT, RRID:SCR_016299)

    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:
    Of the 814 patients included in this study, 13.7% were hospitalised, which is lower than the figures found in the literature (20%)33 and is one of the major limitations of the study. This can be explained by the fact that the patients self-referred and were generally younger (mean age 46.8-years). Thus, our conclusions on the interpretation of NEWS-2 refer to this population and are not representative of the overall hospitalised population. Using NEWS-2 >5 as the criterion for disposition misclassified 25 patients. For patients with dyspnoea or acute pain, NEWS-2 was positively affected by pulse rate and respiratory rate. The number of DH patients with a high NEWS-2 could have been reduced by repeating the score after analgesic treatment or reassurance. Elderly patients were more often admitted to hospital despite a low NEWS-2, as their general condition (e.g. anorexia, vomiting, dehydration), degree of pulmonary damage and associated risk factors (e.g. diabetes, high blood pressure, stroke, immunosuppression, myocardial infarction history and chronic lung disease) seem to be important elements for the ED team deciding on hospital admission. Social isolation was another risk factor taken into account by ED practitioners. The addition of these parameters to NEWS-2 could have an influence on decisions for hospital admission, but would add complexity to data recording and processing. The study population was selected using a clinical questionnaire at the ED entrance to reflect t...

    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.

    Results from scite Reference Check: We found no unreliable references.

    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 10.1101/2021.06.10.21254528v1 on medRxiv