The Prognostics Accuracy of Early Warning Score Screening in Patients with COVID-19: A Literature Review
The accuracy of an early warning score (EWS) in early identification of a patient’s condition can help healthcare workers to promptly and appropriately identify therapy for the patient; it is also used to determine which patients will go to the emergency room, and to monitor the patient’s condition while in the hospital. There are no comprehensive syntheses of the current prognostics accuracy of EWS screening in patients with COVID-19. This review aimed to identify published articles that described EWS accuracy and parameters used in EWS screening. A systematic search of four databases (Science Direct, Pubmed, Google Scholar, and Proquest) was conducted to identify articles describing prognostics accuracy of EWS screening in patients with COVID-19. The EWS, its parameter and its components were extracted and narratively synthesized to identify patterns and themes across the types of EWS. A total of 10 articles describing EWS systems were identified. It was found that the National Early Warning Score (NEWS), National Early Warning Score 2 (NEWS2), Standardized Early Warning Score (SEWS), and Modified Early Warning Score (MEWS) had accurate results ranging from 81-92% sensitivity, specificity of 78-84%, and accuracy of 90-96%. Finally, those EWS systems were shown to perform remarkably well in recognizing a patient’s clinical status at time of admission to the hospital and in determining the appropriate treatment.
Keywords: accuracy, early warning score, COVID-19
 Zhang K, Zhang X, Ding W, Xuan N, Tian B, Huang T, et al. The prognostic accuracy. of national early warning score 2 on predicting clinical deterioration for patients with COVID-19: A systematic review and meta-analysis. Front Med (Lausanne). 2021 Jul;8:699880.
 Wise J. Covid-19: Gighest death rates seen in countries with most overweight populations. BMJ. 2021 Mar;372(623):623.
 WHO. COVID-19 Weekly Epidemiological Update.
 Farrell TW, Ferrante LE, Brown T, Francis L, Widera E, Rhodes R, et al. AGS Position Statement: Resource allocation strategies and age-related considerations in the COVID-19 era and beyond. J Am Geriatr Soc. 2020 Jun;68(6):1136–42.
 Yang P, Wang P, Song Y, Zhang A, Yuan G, Cui Y. A retrospective study on the epidemiological characteristics and establishment of an early warning system of severe COVID-19 patients. J Med Virol. 2020 Oct;92(10):2173–80.
 Covino M, Sandroni C, Santoro M, Sabia L, Simeoni B, Bocci MG, et al. Predicting intensive care unit admission and death for COVID-19 patients in the emergency department using early warning scores. Resuscitation. 2020 Nov;156:84–91.
 Royal College of Physicians. National Early Warning Score (NEWS). Standardising the Assessment of Acute-Illness Severity in the NHS; 2012.
 Royal College of Physicians. National Early Warning Score (NEWS) 2. Standardising the Assessment of Acute-Illness Severity in the NHS; 2017.
 Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009 Jul;339(1):2700.
 JBI. Critical Appraisal Tools [Internet]. 2020. Available from: https://jbi.global/criticalappraisal-tools
 Jang JG, Hur J, Hong KS, Lee W, Ahn JH. Prognostic Accuracy of the SIRS, qSOFA, and NEWS for early detection of clinical deterioration in SARS-CoV-2 INFECTED PATIENTS [Internet]. J Korean Med Sci. 2020 Jun;35(25):e234–234. Available from: https://pubmed.ncbi.nlm.nih.gov/32597046
 Kostakis I, Smith GB, Prytherch D, Meredith P, Price C, Chauhan A, et al. The performance of the National Early Warning Score and National Early Warning Score 2 in hospitalised patients infected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Resuscitation [Internet]. 2021 Feb;159:150–7. Available from: https://pubmed.ncbi.nlm.nih.gov/33176170
 Gidari A, De Socio GV, Sabbatini S, Francisci D. Predictive value of National Early Warning Score 2 (NEWS2) for intensive care unit admission in patients with SARSCoV-2 infection. Infect Dis (Lond). 2020 Oct;52(10):698–704.
 Baker KF, Hanrath AT, Schim van der Loeff I, Kay LJ, Back J, Duncan CJ. National Early Warning Score 2 (NEWS2) to identify inpatient COVID-19 deterioration: a. retrospective analysis. Clin Med (Lond) [Internet]. 2021 Mar;21(2):84–9. Available from: https://pubmed.ncbi.nlm.nih.gov/33547065
 Myrstad M, Ihle-Hansen H, Tveita AA, Andersen EL, Nygård S, Tveit A, et al. National Early Warning Score 2 (NEWS2) on admission predicts severe disease and in-hospital. mortality from Covid-19 - A prospective cohort study [Internet]. Scand J Trauma Resusc Emerg Med. 2020 Jul;28(1):66.
 Saberian P, Tavakoli N, Hasani-Sharamin P, Modabber M, Jamshididana M, Baratloo A. Accuracy of the pre-hospital triage tools (qSOFA, NEWS, and PRESEP) in predicting probable COVID-19 patients’ outcomes transferred by Emergency Medical Services [Internet]. Caspian J Intern Med. 2020;11 Suppl 1:536–43. Available from: https://pubmed.ncbi.nlm.nih.gov/33425272
 Wang L, Lv Q, Zhang X, Jiang B, Liu E, Xiao C, et al. The utility of MEWS for predicting the mortality in the elderly adults with COVID-19: a retrospective cohort study with comparison to other predictive clinical scores. PeerJ. 2020 Sep;8:10018.
 Hu H, Yao N, Qiu Y. Predictive value of five early warning scores for critical novel coronavirus disease. Disaster Med Public Health Prep. 2020.