Predictive Value of an Age-Based Modification of the National Early Warning System in Hospitalized Patients With COVID-19 | Zendy

Ryan C. Maves | Zendy; Stephanie A Richard | Zendy; David A Lindholm | Zendy; Nusrat J Epsi | Zendy; Derek Larson | Zendy; Christian C. Conlon | Zendy; K Everson | Zendy; Steffen Lis | Zendy; Paul W. Blair | Zendy; Sharon Chi | Zendy; Anuradha Ganesan | Zendy; Simon Pollett | Zendy; Timothy Burgess | Zendy; Brian K. Agan | Zendy; Rhonda E Colombo | Zendy; Christopher Colombo | Zendy; John D. Cowden | Zendy; Ana E Markelz | Zendy; Katrin Mende | Zendy; S Merritt | Zendy; T. Allen Merritt | Zendy; Robert Walter | Zendy; T Wellington | Zendy; S Bazan | Zendy; Shan Michel | Zendy; Lisa Brandon | Zendy; Evan Ewers | Zendy; K Gallagher | Zendy; M Odom | Zendy; C. Conlon | Zendy; P Faestel | Zendy; Tomika Ferguson | Zendy; Leo I. Gordon | Zendy; Sarah Grogan | Zendy; M Martin | Zendy; C Mount | Zendy; D Musfeldt | Zendy; D Odineal | Zendy; W Robb-McGrath | Zendy; Rebecca Sainato | Zendy; Carin Schofield | Zendy; Caroline Skinner | Zendy; Michal Stein | Zendy; Mary E. Switzer | Zendy; M Timlin | Zendy; Sheri L. Wood | Zendy; Gerald F. Atwood | Zendy; R Carpenter | Zendy; C Eickhoff | Zendy; Karl Kronmann | Zendy; Tahaniyat Lalani | Zendy; T Lee | Zendy; Tyler Warkentien | Zendy; John Arnold | Zendy; Catherine M Berjohn | Zendy; Syed Arshad Husain | Zendy; N Kirkland | Zendy; Alexandra Lane | Zendy; Scott Parrish | Zendy; Gregory Utz | Zendy; E Filan | Zendy; K Fong | Zendy; Susan G. Hopkinson | Zendy; Timothy S. Horseman | Zendy; Milissa U. Jones | Zendy; A Kanis | Zendy; A Kayatani | Zendy; William Londeree | Zendy; Cristian Madar | Zendy; Joanna Masel | Zendy; Melissa McMahon | Zendy; K Miyasato | Zendy; Gavin Murphy | Zendy; V Nguay | Zendy; Katherine O’Connor | Zendy; Paul E. Schmidt | Zendy; E Schoenman | Zendy; S Scrivner | Zendy; Catherine Uyehara | Zendy; Rachel Villacorta-Lyew | Zendy; Christopher C. Broder | Zendy; Debra J. Brody | Zendy; Celia Byrne | Zendy; Kevin K. Chung | Zendy; C Coles | Zendy; Clifton L. Dalgard | Zendy; J. Stephen Dumler | Zendy; C English | Zendy; Mark C. Haigney | Zendy; Peter Hickey | Zendy; Eric D. Laing | Zendy; Jeffrey Livezey | Zendy; Allison M.W. Malloy | Zendy; R McLeroy | Zendy; Eugene V. Millar | Zendy; Tony Oliver | Zendy; Michael Rajnik | Zendy; Julia S Rozman | Zendy; Jennifer A. Rusiecki | Zendy; Marta López Sánchez | Zendy; I Scher | Zendy; Mark P. Simons | Zendy; Andrew L. Snow | Zendy; David R. Tribble | Zendy; Isha Berry | Zendy; Jesse W. Currier | Zendy; Janice M. Darden | Zendy; Hans Friberg | Zendy; Charlotte Lanteri | Zendy; Sheila A. Peel | Zendy; Padma Bhatia | Zendy; Nikhil Huprikar | Zendy; M Oyeneyin | Zendy; M Banda | Zendy; Bradley N Manktelow | Zendy; T Hunter | Zendy; O Ikpekpe-Magege | Zendy; Steven A. Kemp | Zendy; Rupal Mody | Zendy; Roy G. Resendez | Zendy; Adam Farmer | Zendy; David C. Hostler | Zendy; Carlos J Maldonado | Zendy; J Mehrer | Zendy; Rachel Radcliffe | Zendy; D Shaha | Zendy; M Swain | Zendy; Jeremy C. Weiss | Zendy

Open Access

Predictive Value of an Age-Based Modification of the National Early Warning System in Hospitalized Patients With COVID-19

Author(s) -

Ryan C. Maves,

Stephanie A Richard,

David A Lindholm,

Nusrat J Epsi,

Derek Larson,

Christian C. Conlon,

K Everson,

Steffen Lis,

Paul W. Blair,

Sharon Chi,

Anuradha Ganesan,

Simon Pollett,

Timothy Burgess,

Brian K. Agan,

Rhonda E Colombo,

Christopher Colombo,

John D. Cowden,

Ana E Markelz,

Katrin Mende,

S Merritt,

T. Allen Merritt,

Robert Walter,

T Wellington,

S Bazan,

Shan Michel,

Lisa Brandon,

Evan Ewers,

K Gallagher,

M Odom,

C. Conlon,

P Faestel,

Tomika Ferguson,

Leo I. Gordon,

Sarah Grogan,

M Martin,

C Mount,

D Musfeldt,

D Odineal,

W Robb-McGrath,

Rebecca Sainato,

Carin Schofield,

Caroline Skinner,

Michal Stein,

Mary E. Switzer,

M Timlin,

Sheri L. Wood,

Gerald F. Atwood,

R Carpenter,

C Eickhoff,

Karl Kronmann,

Tahaniyat Lalani,

T Lee,

Tyler Warkentien,

John Arnold,

Catherine M Berjohn,

Syed Arshad Husain,

N Kirkland,

Alexandra Lane,

Scott Parrish,

Gregory Utz,

E Filan,

K Fong,

Susan G. Hopkinson,

Timothy S. Horseman,

Milissa U. Jones,

A Kanis,

A Kayatani,

William Londeree,

Cristian Madar,

Joanna Masel,

Melissa McMahon,

K Miyasato,

Gavin Murphy,

V Nguay,

Katherine O’Connor,

Paul E. Schmidt,

E Schoenman,

S Scrivner,

Catherine Uyehara,

Rachel Villacorta-Lyew,

Christopher C. Broder,

Debra J. Brody,

Celia Byrne,

Kevin K. Chung,

C Coles,

Clifton L. Dalgard,

J. Stephen Dumler,

C English,

Mark C. Haigney,

Peter Hickey,

Eric D. Laing,

Jeffrey Livezey,

Allison M.W. Malloy,

R McLeroy,

Eugene V. Millar,

Tony Oliver,

Michael Rajnik,

Julia S Rozman,

Jennifer A. Rusiecki,

Marta López Sánchez,

I Scher,

Mark P. Simons,

Andrew L. Snow,

David R. Tribble,

Isha Berry,

Jesse W. Currier,

Janice M. Darden,

Hans Friberg,

Charlotte Lanteri,

Sheila A. Peel,

Padma Bhatia,

Nikhil Huprikar,

M Oyeneyin,

M Banda,

Bradley N Manktelow,

T Hunter,

O Ikpekpe-Magege,

Steven A. Kemp,

Rupal Mody,

Roy G. Resendez,

Adam Farmer,

David C. Hostler,

Carlos J Maldonado,

J Mehrer,

Rachel Radcliffe,

D Shaha,

M Swain,

Jeremy C. Weiss

Publication year - 2021

Publication title -

open forum infectious diseases

Language(s) - English

Resource type - Journals

SCImago Journal Rank - 1.546

H-Index - 35

ISSN - 2328-8957

DOI - 10.1093/ofid/ofab421

Subject(s) - medicine , early warning score , receiver operating characteristic , covid-19 , prospective cohort study , observational study , mechanical ventilation , emergency medicine , disease , infectious disease (medical specialty)

Background Early recognition of high-risk patients with coronavirus disease 2019 (COVID-19) may improve outcomes. Although many predictive scoring systems exist, their complexity may limit utility in COVID-19. We assessed the prognostic performance of the National Early Warning Score (NEWS) and an age-based modification (NEWS+age) among hospitalized COVID-19 patients enrolled in a prospective, multicenter US Military Health System (MHS) observational cohort study. Methods Hospitalized adults with confirmed COVID-19 not requiring invasive mechanical ventilation at admission and with a baseline NEWS were included. We analyzed each scoring system’s ability to predict key clinical outcomes, including progression to invasive ventilation or death, stratified by baseline severity (low [0–3], medium [4–6], and high [≥7]). Results Among 184 included participants, those with low baseline NEWS had significantly shorter hospitalizations (P < .01) and lower maximum illness severity (P < .001). Most (80.2%) of low NEWS vs 15.8% of high NEWS participants required no or at most low-flow oxygen supplementation. Low NEWS (≤3) had a negative predictive value of 97.2% for progression to invasive ventilation or death; a high NEWS (≥7) had high specificity (93.1%) but low positive predictive value (42.1%) for such progression. NEWS+age performed similarly to NEWS at predicting invasive ventilation or death (NEWS+age: area under the receiver operating characteristics curve [AUROC], 0.69; 95% CI, 0.65–0.73; NEWS: AUROC, 0.70; 95% CI, 0.66–0.75). Conclusions NEWS and NEWS+age showed similar test characteristics in an MHS COVID-19 cohort. Notably, low baseline scores had an excellent negative predictive value. Given their easy applicability, these scoring systems may be useful in resource-limited settings to identify COVID-19 patients who are unlikely to progress to critical illness.

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