Application of the National Early Warning Score in patients with suspected COVID-19 in Korea

Background: Coronavirus disease 2019 (COVID-19) infection has a wide range of severity, ranging from asymptomatic infection to severe respiratory distress and multiple organ dysfunction. To optimize the utilization of limited resources, a system is needed to rapidly classify the patients requiring monitoring and urgent intervention. The purpose of this study was to determine whether the National Early Warning Score (NEWS) at admission is a useful prediction tool for in-hospital mortality in patients who visited the emergency department (ED) and required isolation during the COVID-19 pandemic. Methods: This study was conducted in adults aged 19 years or older who visited the ED and were preemptively isolated due to fever or respiratory symptoms from January 2021 to December 2021. The NEWS was calculated at the time of ED admission. The primary outcome was all-cause in-hospital mortality. Results: Of the 6304 patients included in the study, 5759 survived and 545 died in the hospital. The NEWS was higher in non-survivors (6.1 ± 4.2) than in survivors (2.8 ± 2.5). When the NEWS was examined as a continuous variable, the adjusted odds ratio for in-hospital mortality was 1.176 (95% CI, 1.12–1.23). The area under the curve (AUC) of NEWS for predicting in-hospital mortality was 0.756 (95% CI, 0.734–0.778). Conclusions: The NEWS at ED admission was associated with in-hospital mortality in preemptively isolated patients during the COVID-19 pandemic. The use of NEWS in patients with suspected COVID-19 infection would help predict the severity and prognosis of patients.