Modified National Early Warning Score As Early Predictor of Outcome In COVID-19 Pandemic

Abstract

Aim: COVID-19 represented an important challenge to the Italian health care system (IHCS). Our main aim was to obtain evidence to support the use of modified national early warning score (m-NEWS) as an interdisciplinary, common and universal scoring scale to quickly recognize patients with a risk of clinical deterioration before admission and during hospitalization. As a secondary goal, we tried to find a score threshold that can be implemented in an optimal triaging protocol for an emergency setting where healthcare resources are overloaded as happened during COVID-19 pandemic. Methods: We performed a retrospective observational study. We included in our study all patients treated for COVID-19 infection in surgical departments between 01 March 2020 and 16 April 2020. Patients with negative test results for SARS-COV2 were excluded. m-NEWS score was obtained twice a day. Patients’ m-NEWS scores were analyzed in order to verify the correlation between m-NEWS (at admission and m-NEWS variation 24h after admission) and outcome (positive outcome-survival, negative outcome- death or intensive care unit (ICU) transfer). Results: We included a population based sample of 225 Sars Cov-2 infected patients. Overall, the average age at hospitalization was 71 (ranging from 40 to 95). 144 (64%) patients were males and 81 (36%) females. m-NEWS values lower or equal to 7 were associated to the majority of the "recovered" population (100/132 75,75%) and at the same time to the minority of the "non recovered" population (25/93 26,88%). Conclusions: For our sample, age is statistically correlated to the outcome but a triage protocol based solely on this variable is less effective than m-NEWS, which showed to be a reliable and easy-to-use score for first patient evaluation. Our observations pave the way towards further studies aiming at optimizing territorial and community healthcare management protocols.