16 March 2022
Using National Early Warning Scores (NEWS2) can help identify those COVID-19 patients who are sickest and at risk of dying, a study published in Emergency Medicine Journal has shown. National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) funded researchers looked at data from 1,263 COVID-19 patients admitted to four hospitals in the West of England between March and June 2020.
They found that using NEWS2, which is already a standard part of hospital care, to monitor patients helped identify those who were more likely to go into intensive care, have a longer hospital stay or die during their stay. Having higher scores was associated with an increased risk of dying.
NEWS2 is a simple scoring system that measures six vital signs, including respiratory rate, oxygen saturation, heart rate and temperature. Each of these is scored from 0 to 3, with two more points added if the patient has been given oxygen. The scores are added together to give an overall score between 0 and 20. Higher totals suggest that a patient is more unwell.
During the early stages of the pandemic, evidence suggested that NEWS2 measurements such as oxygen saturation are different in COVID-19 patients, compared to other patients. It wasn’t clear whether the NEWS2 scoring system or any of its six measurements could help identify which patients with COVID-19 were getting worse. This study aimed to understand whether the NEWS2 measurements could help identify COVID-19 patients who are at risk of getting worse.
The researchers found that 26 per cent of the patients died during their time in hospital, 7 per cent went into intensive care and were subsequently discharged from hospital, and 67 per cent left hospital without having to go to intensive care. Most patients had low scores at first, but many patients had a high maximum score. Patients with higher first and maximum scores were more likely to go into intensive care, have a longer hospital stay or die during their stay. Having higher scores was associated with an increased risk of dying.
These results show that NEWS2 is fairly good at predicting who is likely to die from COVID-19 in hospital. The respiratory elements are the most useful measures, and the findings add weight to the need for oximetry monitoring of COVID patients.
The hospital trusts involved in the project were Great Western Hospitals NHS Foundation Trust, North Bristol Trust, Royal United Hospitals Bath NHS Foundation Trust and University Hospitals Bristol and Weston NHS Foundation Trust. This project was a collaboration with the West of England Academic Health Science Network (AHSN).
Anne Pullyblank, Consultant Surgeon at North Bristol Trust and Medical Director of the West of England AHSN, said:
“We know that NEWS2 can predict a patient’s deterioration from any cause. It was reassuring to prove that this also applies to COVID-19 and that the NEWS2 score, already used in hospitals all over the country, can predict which patients are sickest and which are likely to get worse. The fact that the oxygen levels and respiratory rate are the most sensitive has also helped us understand how we can monitor patients with COVID-19 safely in the community.”
Lauren Scott, Senior Research Associate at NIHR ARC West and lead author on the paper, said:
“In the early days of the pandemic, some COVID-19 patients seemed relatively well, with apparently normal respiratory rates, but in fact had very low oxygen levels. Healthcare staff call this ‘happy hypoxia’. This made clinicians wonder if NEWS2, a tool used every day to monitor patients’ condition in hospital, would be able to predict which COVID-19 patients were likely to get very ill or even die from the disease.
“Our results show that NEWS2 is reasonably good at predicting who is likely to die from COVID-19 in hospital. Of the six items that are monitored with NEWS2, the respiratory elements are the most useful measures for COVID-19 patients. Our findings also support the need for oximetry monitoring among COVID patients.”
These findings support the Royal College of Physician’s recommendations to use NEWS2, alongside clinical judgement, when assessing COVID-19 patients.