Performance Analysis of the National Early Warning Score and Modified Early Warning Score in the Adaptive COVID-19 Treatment Trial Cohort

OBJECTIVES:. We sought to validate prognostic scores in coronavirus disease 2019 including National Early Warning Score, Modified Early Warning Score, and age-based modifications, and define their performance characteristics. DESIGN:. We analyzed prospectively collected data from the Adaptive COVID-...

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Autores principales:	Christopher J. Colombo, MD, MA, FACP, FCCM, Rhonda E. Colombo, MD, MHS, FACP, FIDSA, Ryan C. Maves, MD, FCCM, FCCP, FIDSA, Angela R. Branche, MD, Stuart H. Cohen, MD, Marie-Carmelle Elie, MD, Sarah L. George, MD, Hannah J. Jang, PhD, RN, CNL, PHN, Andre C. Kalil, MD, MPH, David A. Lindholm, MD, FACP, Richard A. Mularski, MD, MSHS, MCR, ATSF, FCCP, FACP, Justin R. Ortiz, MD, MS, FACP, FCCP, Victor Tapson, MD, C. Jason Liang, PhD, On behalf of the ACTT-1 Study Group, Aneesh K. Mehta, Nadine G. Rouphael, Jessica J. Traenkner, Valeria D Cantos, Ghina Alaaeddine, Barry S. Zingman, Robert Grossberg, Paul F. Riska, Elizabeth Hohmann, Mariam Torres-Soto, Nikolaus Jilg, Helen Y. Chu, Anna Wald, Margaret Green, Annie Luetkemeyer, Pierre-Cedric B. Crouch, Hannah Jang, Susan Kline, Joanne Billings, Brooke Noren, Diego Lopez de Castilla, Jason W. Van Winkle, Francis X. Riedo, Robert W. Finberg, Jennifer P. Wang, Mireya Wessolossky, Kerry Dierberg, Benjamin Eckhardt, Henry J Neumann, Victor Tapson, Jonathan Grein, Fayyaz Sutterwala, Lanny Hsieh, Alpesh N. Amin, Thomas F. Patterson, Heta Javeri, Trung Vu, Roger Paredes, Lourdes Mateu, Daniel A. Sweeney, Constance A. Benson, Farhana Ali, William R. Short, Pablo Tebas, Jessie Torgersen, Giota Touloumi, Vicky Gioukari, David Chien Lye, Sean WX Ong, Norio Ohmagari, Ayako Mikami, Gerd Fätkenheuer, Jakob J. Malin, Philipp Koehler, Andre C. Kalil, LuAnn Larson, Angela Hewlett, Mark G. Kortepeter, C. Buddy Creech, Isaac Thomsen, Todd W. Rice, Babafemi Taiwo, Karen Krueger, Stuart H. Cohen, George R. Thompson, 3rd, Cameron Wolfe, Emmanuel B. Walter, Maria Frank, Heather Young, Ann R. Falsey, Angela R. Branche, Paul Goepfert, Nathaniel Erdmann, Otto O. Yang, Jenny Ahn, Anna Goodman, Blair Merrick, Richard M. Novak, Andrea Wendrow, Henry Arguinchona, Christa Arguinchona, Sarah L. George, Janice Tennant, Robert L. Atmar, Hana M. El Sahly, Jennifer Whitaker, D. Ashley Price, Christopher J. A. Duncan, Simeon Metallidis, Theofilos Chrysanthidis, F. McLellan, Myoung-don Oh, Wan Beom Park, Eu Suk Kim, Jongtak Jung, Justin R. Ortiz, Karen L. Kotloff, Brian Angus, Jack David Germain Seymour, Noreen A. Hynes, Lauren M. Sauer, Neera Ahuja, Kari Nadeau, Patrick E. H. Jackson, Taison D. Bell, Anastasia Antoniadou, Konstantinos Protopapas, Richard T Davey, Jocelyn D. Voell, Jose Muñoz, Montserrat Roldan, Ioannis Kalomenidis, Spyros G. Zakynthinos, Catharine I. Paules, Fiona McGill, Jane Minton, Nikolaos Koulouris, Zafeiria Barmparessou, Edwin Swiatlo, Kyle Widmer, Nikhil Huprikar, Anuradha Ganesan, Guillermo M. Ruiz-Palacios, Alfredo Ponce de León, Sandra Rajme, Justino Regalado Pineda, José Arturo Martinez-Orozco, Mark Holodniy, Aarthi Chary, Timo Wolf, Christoph Stephan, Jan-Christian Wasmuth, Christoph Boesecke, Martin Llewelyn, Barbara Philips, Christopher J. Colombo, Rhonda E. Colombo, David A. Lindholm, Katrin Mende, Tida Lee, Tahaniyat Lalani, Ryan C. Maves, Gregory C. Utz, Jens Lundgren, Marie Helleberg, Jan Gerstoft, Thomas Benfield, Tomas Jensen, Birgitte Lindegaard, Lothar Weise, Lene Knudsen, Isik Johansen, Lone W Madsen, Lars Østergaard, Nina Stærke, Henrik Nielsen, Timothy H. Burgess, Michelle Green, Mat Makowski, Jennifer L. Ferreira, Michael R. Wierzbicki, Tyler Bonnett, Nikki Gettinger, Theresa Engel, Jing Wang, John H. Beigel, Kay M. Tomashek, Seema Nayak, Lori E. Dodd, Walla Dempsey, Effie Nomicos, Marina Lee, Peter Wolff, Rhonda PikaartTautges, Mohamed Elsafy, Robert Jurao, Hyung Koo, Michael Proschan, Dean Follmann, H. Clifford Lane
Formato:	article
Lenguaje:	EN
Publicado:	Wolters Kluwer 2021
Materias:	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/f711c9ef6fc84224b75ad839ed7e126c
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id	oai:doaj.org-article:f711c9ef6fc84224b75ad839ed7e126c
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institution	DOAJ
collection	DOAJ
language	EN
topic	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Christopher J. Colombo, MD, MA, FACP, FCCM Rhonda E. Colombo, MD, MHS, FACP, FIDSA Ryan C. Maves, MD, FCCM, FCCP, FIDSA Angela R. Branche, MD Stuart H. Cohen, MD Marie-Carmelle Elie, MD Sarah L. George, MD Hannah J. Jang, PhD, RN, CNL, PHN Andre C. Kalil, MD, MPH David A. Lindholm, MD, FACP Richard A. Mularski, MD, MSHS, MCR, ATSF, FCCP, FACP Justin R. Ortiz, MD, MS, FACP, FCCP Victor Tapson, MD C. Jason Liang, PhD On behalf of the ACTT-1 Study Group Aneesh K. Mehta Nadine G. Rouphael Jessica J. Traenkner Valeria D Cantos Ghina Alaaeddine Barry S. Zingman Robert Grossberg Paul F. Riska Elizabeth Hohmann Mariam Torres-Soto Nikolaus Jilg Helen Y. Chu Anna Wald Margaret Green Annie Luetkemeyer Pierre-Cedric B. Crouch Hannah Jang Susan Kline Joanne Billings Brooke Noren Diego Lopez de Castilla Jason W. Van Winkle Francis X. Riedo Robert W. Finberg Jennifer P. Wang Mireya Wessolossky Kerry Dierberg Benjamin Eckhardt Henry J Neumann Victor Tapson Jonathan Grein Fayyaz Sutterwala Lanny Hsieh Alpesh N. Amin Thomas F. Patterson Heta Javeri Trung Vu Roger Paredes Lourdes Mateu Daniel A. Sweeney Constance A. Benson Farhana Ali William R. Short Pablo Tebas Jessie Torgersen Giota Touloumi Vicky Gioukari David Chien Lye Sean WX Ong Norio Ohmagari Ayako Mikami Gerd Fätkenheuer Jakob J. Malin Philipp Koehler Andre C. Kalil LuAnn Larson Angela Hewlett Mark G. Kortepeter C. Buddy Creech Isaac Thomsen Todd W. Rice Babafemi Taiwo Karen Krueger Stuart H. Cohen George R. Thompson, 3rd Cameron Wolfe Emmanuel B. Walter Maria Frank Heather Young Ann R. Falsey Angela R. Branche Paul Goepfert Nathaniel Erdmann Otto O. Yang Jenny Ahn Anna Goodman Blair Merrick Richard M. Novak Andrea Wendrow Henry Arguinchona Christa Arguinchona Sarah L. George Janice Tennant Robert L. Atmar Hana M. El Sahly Jennifer Whitaker D. Ashley Price Christopher J. A. Duncan Simeon Metallidis Theofilos Chrysanthidis F. McLellan Myoung-don Oh Wan Beom Park Eu Suk Kim Jongtak Jung Justin R. Ortiz Karen L. Kotloff Brian Angus Jack David Germain Seymour Noreen A. Hynes Lauren M. Sauer Neera Ahuja Kari Nadeau Patrick E. H. Jackson Taison D. Bell Anastasia Antoniadou Konstantinos Protopapas Richard T Davey Jocelyn D. Voell Jose Muñoz Montserrat Roldan Ioannis Kalomenidis Spyros G. Zakynthinos Catharine I. Paules Fiona McGill Jane Minton Nikolaos Koulouris Zafeiria Barmparessou Edwin Swiatlo Kyle Widmer Nikhil Huprikar Anuradha Ganesan Guillermo M. Ruiz-Palacios Alfredo Ponce de León Sandra Rajme Justino Regalado Pineda José Arturo Martinez-Orozco Mark Holodniy Aarthi Chary Timo Wolf Christoph Stephan Jan-Christian Wasmuth Christoph Boesecke Martin Llewelyn Barbara Philips Christopher J. Colombo Rhonda E. Colombo David A. Lindholm Katrin Mende Tida Lee Tahaniyat Lalani Ryan C. Maves Gregory C. Utz Jens Lundgren Marie Helleberg Jan Gerstoft Thomas Benfield Tomas Jensen Birgitte Lindegaard Lothar Weise Lene Knudsen Isik Johansen Lone W Madsen Lars Østergaard Nina Stærke Henrik Nielsen Timothy H. Burgess Michelle Green Mat Makowski Jennifer L. Ferreira Michael R. Wierzbicki Tyler Bonnett Nikki Gettinger Theresa Engel Jing Wang John H. Beigel Kay M. Tomashek Seema Nayak Lori E. Dodd Walla Dempsey Effie Nomicos Marina Lee Peter Wolff Rhonda PikaartTautges Mohamed Elsafy Robert Jurao Hyung Koo Michael Proschan Dean Follmann H. Clifford Lane Performance Analysis of the National Early Warning Score and Modified Early Warning Score in the Adaptive COVID-19 Treatment Trial Cohort
description	OBJECTIVES:. We sought to validate prognostic scores in coronavirus disease 2019 including National Early Warning Score, Modified Early Warning Score, and age-based modifications, and define their performance characteristics. DESIGN:. We analyzed prospectively collected data from the Adaptive COVID-19 Treatment Trial. National Early Warning Score was collected daily during the trial, Modified Early Warning Score was calculated, and age applied to both scores. We assessed prognostic value for the end points of recovery, mechanical ventilation, and death for score at enrollment, average, and slope of score over the first 48 hours. SETTING:. A multisite international inpatient trial. PATIENTS:. A total of 1,062 adult nonpregnant inpatients with severe coronavirus disease 2019 pneumonia. INTERVENTIONS:. Adaptive COVID-19 Treatment Trial 1 randomized participants to receive remdesivir or placebo. The prognostic value of predictive scores was evaluated in both groups separately to assess for differential performance in the setting of remdesivir treatment. MEASUREMENTS AND MAIN RESULTS:. For mortality, baseline National Early Warning Score and Modified Early Warning Score were weakly to moderately prognostic (c-index, 0.60–0.68), and improved with addition of age (c-index, 0.66–0.74). For recovery, baseline National Early Warning Score and Modified Early Warning Score demonstrated somewhat better prognostic ability (c-index, 0.65–0.69); however, National Early Warning Score+age and Modified Early Warning Score+age further improved performance (c-index, 0.68–0.71). For deterioration, baseline National Early Warning Score and Modified Early Warning Score were weakly to moderately prognostic (c-index, 0.59–0.69) and improved with addition of age (c-index, 0.63–0.70). All prognostic performance improvements due to addition of age were significant (p < 0.05). CONCLUSIONS:. In the Adaptive COVID-19 Treatment Trial 1 cohort, National Early Warning Score and Modified Early Warning Score demonstrated moderate prognostic performance in patients with severe coronavirus disease 2019, with improvement in predictive ability for National Early Warning Score+age and Modified Early Warning Score+age. Area under receiver operating curve for National Early Warning Score and Modified Early Warning Score improved in patients receiving remdesivir versus placebo early in the pandemic for recovery and mortality. Although these scores are simple and readily obtainable in myriad settings, in our data set, they were insufficiently predictive to completely replace clinical judgment in coronavirus disease 2019 and may serve best as an adjunct to triage, disposition, and resourcing decisions.
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author	Christopher J. Colombo, MD, MA, FACP, FCCM Rhonda E. Colombo, MD, MHS, FACP, FIDSA Ryan C. Maves, MD, FCCM, FCCP, FIDSA Angela R. Branche, MD Stuart H. Cohen, MD Marie-Carmelle Elie, MD Sarah L. George, MD Hannah J. Jang, PhD, RN, CNL, PHN Andre C. Kalil, MD, MPH David A. Lindholm, MD, FACP Richard A. Mularski, MD, MSHS, MCR, ATSF, FCCP, FACP Justin R. Ortiz, MD, MS, FACP, FCCP Victor Tapson, MD C. Jason Liang, PhD On behalf of the ACTT-1 Study Group Aneesh K. Mehta Nadine G. Rouphael Jessica J. Traenkner Valeria D Cantos Ghina Alaaeddine Barry S. Zingman Robert Grossberg Paul F. Riska Elizabeth Hohmann Mariam Torres-Soto Nikolaus Jilg Helen Y. Chu Anna Wald Margaret Green Annie Luetkemeyer Pierre-Cedric B. Crouch Hannah Jang Susan Kline Joanne Billings Brooke Noren Diego Lopez de Castilla Jason W. Van Winkle Francis X. Riedo Robert W. Finberg Jennifer P. Wang Mireya Wessolossky Kerry Dierberg Benjamin Eckhardt Henry J Neumann Victor Tapson Jonathan Grein Fayyaz Sutterwala Lanny Hsieh Alpesh N. Amin Thomas F. Patterson Heta Javeri Trung Vu Roger Paredes Lourdes Mateu Daniel A. Sweeney Constance A. Benson Farhana Ali William R. Short Pablo Tebas Jessie Torgersen Giota Touloumi Vicky Gioukari David Chien Lye Sean WX Ong Norio Ohmagari Ayako Mikami Gerd Fätkenheuer Jakob J. Malin Philipp Koehler Andre C. Kalil LuAnn Larson Angela Hewlett Mark G. Kortepeter C. Buddy Creech Isaac Thomsen Todd W. Rice Babafemi Taiwo Karen Krueger Stuart H. Cohen George R. Thompson, 3rd Cameron Wolfe Emmanuel B. Walter Maria Frank Heather Young Ann R. Falsey Angela R. Branche Paul Goepfert Nathaniel Erdmann Otto O. Yang Jenny Ahn Anna Goodman Blair Merrick Richard M. Novak Andrea Wendrow Henry Arguinchona Christa Arguinchona Sarah L. George Janice Tennant Robert L. Atmar Hana M. El Sahly Jennifer Whitaker D. Ashley Price Christopher J. A. Duncan Simeon Metallidis Theofilos Chrysanthidis F. McLellan Myoung-don Oh Wan Beom Park Eu Suk Kim Jongtak Jung Justin R. Ortiz Karen L. Kotloff Brian Angus Jack David Germain Seymour Noreen A. Hynes Lauren M. Sauer Neera Ahuja Kari Nadeau Patrick E. H. Jackson Taison D. Bell Anastasia Antoniadou Konstantinos Protopapas Richard T Davey Jocelyn D. Voell Jose Muñoz Montserrat Roldan Ioannis Kalomenidis Spyros G. Zakynthinos Catharine I. Paules Fiona McGill Jane Minton Nikolaos Koulouris Zafeiria Barmparessou Edwin Swiatlo Kyle Widmer Nikhil Huprikar Anuradha Ganesan Guillermo M. Ruiz-Palacios Alfredo Ponce de León Sandra Rajme Justino Regalado Pineda José Arturo Martinez-Orozco Mark Holodniy Aarthi Chary Timo Wolf Christoph Stephan Jan-Christian Wasmuth Christoph Boesecke Martin Llewelyn Barbara Philips Christopher J. Colombo Rhonda E. Colombo David A. Lindholm Katrin Mende Tida Lee Tahaniyat Lalani Ryan C. Maves Gregory C. Utz Jens Lundgren Marie Helleberg Jan Gerstoft Thomas Benfield Tomas Jensen Birgitte Lindegaard Lothar Weise Lene Knudsen Isik Johansen Lone W Madsen Lars Østergaard Nina Stærke Henrik Nielsen Timothy H. Burgess Michelle Green Mat Makowski Jennifer L. Ferreira Michael R. Wierzbicki Tyler Bonnett Nikki Gettinger Theresa Engel Jing Wang John H. Beigel Kay M. Tomashek Seema Nayak Lori E. Dodd Walla Dempsey Effie Nomicos Marina Lee Peter Wolff Rhonda PikaartTautges Mohamed Elsafy Robert Jurao Hyung Koo Michael Proschan Dean Follmann H. Clifford Lane
author_facet	Christopher J. Colombo, MD, MA, FACP, FCCM Rhonda E. Colombo, MD, MHS, FACP, FIDSA Ryan C. Maves, MD, FCCM, FCCP, FIDSA Angela R. Branche, MD Stuart H. Cohen, MD Marie-Carmelle Elie, MD Sarah L. George, MD Hannah J. Jang, PhD, RN, CNL, PHN Andre C. Kalil, MD, MPH David A. Lindholm, MD, FACP Richard A. Mularski, MD, MSHS, MCR, ATSF, FCCP, FACP Justin R. Ortiz, MD, MS, FACP, FCCP Victor Tapson, MD C. Jason Liang, PhD On behalf of the ACTT-1 Study Group Aneesh K. Mehta Nadine G. Rouphael Jessica J. Traenkner Valeria D Cantos Ghina Alaaeddine Barry S. Zingman Robert Grossberg Paul F. Riska Elizabeth Hohmann Mariam Torres-Soto Nikolaus Jilg Helen Y. Chu Anna Wald Margaret Green Annie Luetkemeyer Pierre-Cedric B. Crouch Hannah Jang Susan Kline Joanne Billings Brooke Noren Diego Lopez de Castilla Jason W. Van Winkle Francis X. Riedo Robert W. Finberg Jennifer P. Wang Mireya Wessolossky Kerry Dierberg Benjamin Eckhardt Henry J Neumann Victor Tapson Jonathan Grein Fayyaz Sutterwala Lanny Hsieh Alpesh N. Amin Thomas F. Patterson Heta Javeri Trung Vu Roger Paredes Lourdes Mateu Daniel A. Sweeney Constance A. Benson Farhana Ali William R. Short Pablo Tebas Jessie Torgersen Giota Touloumi Vicky Gioukari David Chien Lye Sean WX Ong Norio Ohmagari Ayako Mikami Gerd Fätkenheuer Jakob J. Malin Philipp Koehler Andre C. Kalil LuAnn Larson Angela Hewlett Mark G. Kortepeter C. Buddy Creech Isaac Thomsen Todd W. Rice Babafemi Taiwo Karen Krueger Stuart H. Cohen George R. Thompson, 3rd Cameron Wolfe Emmanuel B. Walter Maria Frank Heather Young Ann R. Falsey Angela R. Branche Paul Goepfert Nathaniel Erdmann Otto O. Yang Jenny Ahn Anna Goodman Blair Merrick Richard M. Novak Andrea Wendrow Henry Arguinchona Christa Arguinchona Sarah L. George Janice Tennant Robert L. Atmar Hana M. El Sahly Jennifer Whitaker D. Ashley Price Christopher J. A. Duncan Simeon Metallidis Theofilos Chrysanthidis F. McLellan Myoung-don Oh Wan Beom Park Eu Suk Kim Jongtak Jung Justin R. Ortiz Karen L. Kotloff Brian Angus Jack David Germain Seymour Noreen A. Hynes Lauren M. Sauer Neera Ahuja Kari Nadeau Patrick E. H. Jackson Taison D. Bell Anastasia Antoniadou Konstantinos Protopapas Richard T Davey Jocelyn D. Voell Jose Muñoz Montserrat Roldan Ioannis Kalomenidis Spyros G. Zakynthinos Catharine I. Paules Fiona McGill Jane Minton Nikolaos Koulouris Zafeiria Barmparessou Edwin Swiatlo Kyle Widmer Nikhil Huprikar Anuradha Ganesan Guillermo M. Ruiz-Palacios Alfredo Ponce de León Sandra Rajme Justino Regalado Pineda José Arturo Martinez-Orozco Mark Holodniy Aarthi Chary Timo Wolf Christoph Stephan Jan-Christian Wasmuth Christoph Boesecke Martin Llewelyn Barbara Philips Christopher J. Colombo Rhonda E. Colombo David A. Lindholm Katrin Mende Tida Lee Tahaniyat Lalani Ryan C. Maves Gregory C. Utz Jens Lundgren Marie Helleberg Jan Gerstoft Thomas Benfield Tomas Jensen Birgitte Lindegaard Lothar Weise Lene Knudsen Isik Johansen Lone W Madsen Lars Østergaard Nina Stærke Henrik Nielsen Timothy H. Burgess Michelle Green Mat Makowski Jennifer L. Ferreira Michael R. Wierzbicki Tyler Bonnett Nikki Gettinger Theresa Engel Jing Wang John H. Beigel Kay M. Tomashek Seema Nayak Lori E. Dodd Walla Dempsey Effie Nomicos Marina Lee Peter Wolff Rhonda PikaartTautges Mohamed Elsafy Robert Jurao Hyung Koo Michael Proschan Dean Follmann H. Clifford Lane
author_sort	Christopher J. Colombo, MD, MA, FACP, FCCM
title	Performance Analysis of the National Early Warning Score and Modified Early Warning Score in the Adaptive COVID-19 Treatment Trial Cohort
title_short	Performance Analysis of the National Early Warning Score and Modified Early Warning Score in the Adaptive COVID-19 Treatment Trial Cohort
title_full	Performance Analysis of the National Early Warning Score and Modified Early Warning Score in the Adaptive COVID-19 Treatment Trial Cohort
title_fullStr	Performance Analysis of the National Early Warning Score and Modified Early Warning Score in the Adaptive COVID-19 Treatment Trial Cohort
title_full_unstemmed	Performance Analysis of the National Early Warning Score and Modified Early Warning Score in the Adaptive COVID-19 Treatment Trial Cohort
title_sort	performance analysis of the national early warning score and modified early warning score in the adaptive covid-19 treatment trial cohort
publisher	Wolters Kluwer
publishDate	2021
url	https://doaj.org/article/f711c9ef6fc84224b75ad839ed7e126c
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spelling	oai:doaj.org-article:f711c9ef6fc84224b75ad839ed7e126c2021-11-25T07:55:25ZPerformance Analysis of the National Early Warning Score and Modified Early Warning Score in the Adaptive COVID-19 Treatment Trial Cohort2639-802810.1097/CCE.0000000000000474https://doaj.org/article/f711c9ef6fc84224b75ad839ed7e126c2021-07-01T00:00:00Zhttp://journals.lww.com/10.1097/CCE.0000000000000474https://doaj.org/toc/2639-8028OBJECTIVES:. We sought to validate prognostic scores in coronavirus disease 2019 including National Early Warning Score, Modified Early Warning Score, and age-based modifications, and define their performance characteristics. DESIGN:. We analyzed prospectively collected data from the Adaptive COVID-19 Treatment Trial. National Early Warning Score was collected daily during the trial, Modified Early Warning Score was calculated, and age applied to both scores. We assessed prognostic value for the end points of recovery, mechanical ventilation, and death for score at enrollment, average, and slope of score over the first 48 hours. SETTING:. A multisite international inpatient trial. PATIENTS:. A total of 1,062 adult nonpregnant inpatients with severe coronavirus disease 2019 pneumonia. INTERVENTIONS:. Adaptive COVID-19 Treatment Trial 1 randomized participants to receive remdesivir or placebo. The prognostic value of predictive scores was evaluated in both groups separately to assess for differential performance in the setting of remdesivir treatment. MEASUREMENTS AND MAIN RESULTS:. For mortality, baseline National Early Warning Score and Modified Early Warning Score were weakly to moderately prognostic (c-index, 0.60–0.68), and improved with addition of age (c-index, 0.66–0.74). For recovery, baseline National Early Warning Score and Modified Early Warning Score demonstrated somewhat better prognostic ability (c-index, 0.65–0.69); however, National Early Warning Score+age and Modified Early Warning Score+age further improved performance (c-index, 0.68–0.71). For deterioration, baseline National Early Warning Score and Modified Early Warning Score were weakly to moderately prognostic (c-index, 0.59–0.69) and improved with addition of age (c-index, 0.63–0.70). All prognostic performance improvements due to addition of age were significant (p < 0.05). CONCLUSIONS:. In the Adaptive COVID-19 Treatment Trial 1 cohort, National Early Warning Score and Modified Early Warning Score demonstrated moderate prognostic performance in patients with severe coronavirus disease 2019, with improvement in predictive ability for National Early Warning Score+age and Modified Early Warning Score+age. Area under receiver operating curve for National Early Warning Score and Modified Early Warning Score improved in patients receiving remdesivir versus placebo early in the pandemic for recovery and mortality. Although these scores are simple and readily obtainable in myriad settings, in our data set, they were insufficiently predictive to completely replace clinical judgment in coronavirus disease 2019 and may serve best as an adjunct to triage, disposition, and resourcing decisions.Christopher J. Colombo, MD, MA, FACP, FCCMRhonda E. Colombo, MD, MHS, FACP, FIDSARyan C. Maves, MD, FCCM, FCCP, FIDSAAngela R. Branche, MDStuart H. Cohen, MDMarie-Carmelle Elie, MDSarah L. George, MDHannah J. Jang, PhD, RN, CNL, PHNAndre C. Kalil, MD, MPHDavid A. Lindholm, MD, FACPRichard A. Mularski, MD, MSHS, MCR, ATSF, FCCP, FACPJustin R. Ortiz, MD, MS, FACP, FCCPVictor Tapson, MDC. Jason Liang, PhDOn behalf of the ACTT-1 Study GroupAneesh K. MehtaNadine G. RouphaelJessica J. TraenknerValeria D CantosGhina AlaaeddineBarry S. ZingmanRobert GrossbergPaul F. RiskaElizabeth HohmannMariam Torres-SotoNikolaus JilgHelen Y. ChuAnna WaldMargaret GreenAnnie LuetkemeyerPierre-Cedric B. CrouchHannah JangSusan KlineJoanne BillingsBrooke NorenDiego Lopez de CastillaJason W. Van WinkleFrancis X. RiedoRobert W. FinbergJennifer P. WangMireya WessolosskyKerry DierbergBenjamin EckhardtHenry J NeumannVictor TapsonJonathan GreinFayyaz SutterwalaLanny HsiehAlpesh N. AminThomas F. PattersonHeta JaveriTrung VuRoger ParedesLourdes MateuDaniel A. SweeneyConstance A. BensonFarhana AliWilliam R. ShortPablo TebasJessie TorgersenGiota TouloumiVicky GioukariDavid Chien LyeSean WX OngNorio OhmagariAyako MikamiGerd FätkenheuerJakob J. MalinPhilipp KoehlerAndre C. KalilLuAnn LarsonAngela HewlettMark G. KortepeterC. Buddy CreechIsaac ThomsenTodd W. RiceBabafemi TaiwoKaren KruegerStuart H. CohenGeorge R. Thompson, 3rdCameron WolfeEmmanuel B. WalterMaria FrankHeather YoungAnn R. FalseyAngela R. BranchePaul GoepfertNathaniel ErdmannOtto O. YangJenny AhnAnna GoodmanBlair MerrickRichard M. NovakAndrea WendrowHenry ArguinchonaChrista ArguinchonaSarah L. GeorgeJanice TennantRobert L. AtmarHana M. El SahlyJennifer WhitakerD. Ashley PriceChristopher J. A. DuncanSimeon MetallidisTheofilos ChrysanthidisF. McLellanMyoung-don OhWan Beom ParkEu Suk KimJongtak JungJustin R. OrtizKaren L. KotloffBrian AngusJack David Germain SeymourNoreen A. HynesLauren M. SauerNeera AhujaKari NadeauPatrick E. H. JacksonTaison D. BellAnastasia AntoniadouKonstantinos ProtopapasRichard T DaveyJocelyn D. VoellJose MuñozMontserrat RoldanIoannis KalomenidisSpyros G. ZakynthinosCatharine I. PaulesFiona McGillJane MintonNikolaos KoulourisZafeiria BarmparessouEdwin SwiatloKyle WidmerNikhil HuprikarAnuradha GanesanGuillermo M. Ruiz-PalaciosAlfredo Ponce de LeónSandra RajmeJustino Regalado PinedaJosé Arturo Martinez-OrozcoMark HolodniyAarthi CharyTimo WolfChristoph StephanJan-Christian WasmuthChristoph BoeseckeMartin LlewelynBarbara PhilipsChristopher J. ColomboRhonda E. ColomboDavid A. LindholmKatrin MendeTida LeeTahaniyat LalaniRyan C. MavesGregory C. UtzJens LundgrenMarie HellebergJan GerstoftThomas BenfieldTomas JensenBirgitte LindegaardLothar WeiseLene KnudsenIsik JohansenLone W MadsenLars ØstergaardNina StærkeHenrik NielsenTimothy H. BurgessMichelle GreenMat MakowskiJennifer L. FerreiraMichael R. WierzbickiTyler BonnettNikki GettingerTheresa EngelJing WangJohn H. BeigelKay M. TomashekSeema NayakLori E. DoddWalla DempseyEffie NomicosMarina LeePeter WolffRhonda PikaartTautgesMohamed ElsafyRobert JuraoHyung KooMichael ProschanDean FollmannH. Clifford LaneWolters KluwerarticleMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENCritical Care Explorations, Vol 3, Iss 7, p e0474 (2021)

Performance Analysis of the National Early Warning Score and Modified Early Warning Score in the Adaptive COVID-19 Treatment Trial Cohort

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