In the first large-scale systematic evaluation of the UK National Early Warning Risk Score (NEWS) 2 as a scoring system for predicting adverse COVID-19 outcomes in patients, researchers at King’s College London have find that accuracy is moderately low for patient identification. at risk of being transferred to intensive care units (ICUs) or dying after 14 days from hospital. Short-term (three-day) predictive accuracy showed moderate success.
For people who are in hospital with severe COVID-19, it is essential to quickly identify which patients may be debilitated and need to be transferred to an intensive care unit (ICU) for organ support or may die. NEWS2 is an early warning score that combines cognitive parameters such as respiratory rate, oxygen absorption, blood pressure and temperature. NEWS2 is currently used almost universally in UK NHS Trusts to determine which patients are at risk of early relapse.
The paper was published today (Thursday 21 January) in BMC medicine.
Accuracy NEWS2
Researchers analyzed data from 1,276 COVID-19 patients admitted to King’s College Hospital NHS Foundation Trust in the first wave in March-April 2020. The team then tested their models. ‘used data for more than 6,000 patients across eight other hospitals worldwide (five in the UK, one in Norway, and two in China). At all UK sites, about a third of patients with COVID-19 were transferred to an ICU or died within 14 days of hospital admission.
The researchers assessed how well NEWS2 scores of patients measured at the time of admission to hospital had adverse effects of COVID-19, which means both have been the transfer to ICU or die. In all UK sites, combining NEWS2 and age to predict results showed moderate success in the short term (three days), but for moderate to poor success for medium-term results ( 14 days).
Dr Ewan Carr, Statistical Research Fellow at the Institute of Psychology, Psychology & Neo-Psychology, King’s College London, and co-author, said: “We have conducted the largest study to date assessing accuracy NEWS2 for predicting medium-term COVID outcomes. NEWS2 is widely used in UK NHS trusts but there is little information on how well it can predict the adverse effects of COVID so it is important to assess how accurately we want to promote current and future patient care.
By collecting data from nine hospitals worldwide, our results have strong external validation. We found consistency across sites in both NEWS2-only performance, as well as the model developed. In a short time, NEWS2 tended to have moderate to poor performance but was ameliorated by the addition of common blood and psychological measures. “
The research team used CogStack, an existing platform developed by NIHR Maudsley BRC and used by the King’s College Hospital NHS Foundation Trust, which allows extraction and processing fast data from patient electronic health records.
Professor Richard Dobson, Head of the Department of Health Biostatistics & Informatics, NIHR Maudsley BRC, said: “The CogStack platform allows us to extract information from depth within hospital records at the College Hospital NHS Foundation Trust. King in real time to study complex issues. like this. This includes being able to extract information about co-infections, for example, which may be mentioned only in passing in the physician’s statement “
Improving predictability
The researchers found that accuracy in predicting adverse outcomes was improved by considering regularly collected blood and physiological parameters from patients including age, oxygen absorption and neutrophil count, which is an important immune system cell that fights disease. In models that added NEWS2 with these parameters the ability to predict adverse outcomes was developed.
Dr James Ltd, Consultant Neurologist at King ‘s College Hospital and Clinical Director of Data Science and CogStack platform director, said: “Our results for the first time validate NEWS2, and show how it could be improved by common blood transfusion and cognitive parameters Fortunately, this NHS scoring system is easily adaptable and implemented in clinical practice worldwide, compared to other complex risk-scraping models.
I, along with all the authors and colleagues, would like to thank the guidance and contributions of the patients and members of the King’s Electronic Records Research Interface that made all this possible. “
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The study was a collaboration between the Maudsley Biomedical Research Center (BRC) of the National Institute for Health Research (NIHR) and the Medical Research Council (MRC).
Notes to Editors Examined data comes from patients admitted to: King’s College Hospital National Health Service Foundation Trust, Guy and St Thomas NHS Trust Hospitals, Southampton University Hospitals, University Hospitals Bristol and Weston NHS Foundation Trust, University College Hospitals London, Birmingham University Hospitals, one hospital in Norway (Oslo University Hospital), and two hospitals in Wuhan, China (Wuhan Sixth Hospital and Taikang Tongji Hospital).
Contact
To obtain a copy of the embargo paper or to arrange interviews please contact the communications team at NIHR Maudsley BRC:
Alex Booth, Communications and Liaison Manager, NIHR Maudsley Biomedical Research Center, Tel 020 7848 0495 [email protected]
Serena Rianjongdee, Communications and Engagement Officer, NIHR Maudsley Biomedical Research Center, Tel 020 7848 2137 [email protected]
National Institute for Health Research (NIHR)
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About King’s College London and the Institute of Psychology, Psychology & Neo-Psychology
King’s College London is one of the top 10 universities in the world (QS World University Rankings, 2020) and among the oldest in England. King has more than 31,000 students (including more than 12,800 postgraduates) from about 150 countries worldwide, and about 8,500 employees.
The Institute of Psychology, Psychology & Non-Psychology (IoPPN) at King’s College London is the leading center for the study of mental health and related neuroscience in Europe. It delivers higher demand results (1% maximum values) on mental health than any other center (SciVal 2019) and on this metric we have risen from 16th (2014) to 4th (2019) ) on the world for the highly cited neuro-scientific results. World-leading research from the IoPPN has influenced, and continues to influence, our understanding of, prevention and treatment of mental illness and other affective conditions. on the brain. http: // www.