There is no evidence that National early warning scores (NEWS) are useful when managing Covid-19 in a primary care setting, according to researchers from the University of Oxford.
A review carried out by The Centre for Evidence-Based Medicine said that ‘enthusiasm’ for the use of the scoring system for coronavirus outside hospital ‘may be premature’.
The researchers said that NEWS2 blood pressure and oxygen saturation measurements ‘are difficult or impossible to take remotely’, and ‘does not include age or comorbidities, which are known to be strong independent predictors of survival in Covid-19’.
The review into its usefulness for GPs during the current pandemic concluded that ‘there is no research on the value of these tools for Covid-19 outside hospital’.
It said this comes as NEWS, and its updated version NEWS2, have been developed for ‘monitoring hospital in-patients over time using repeated measurements’.
NICE currently recommends the use of NEWS2 for Covid-19 patients in critical care in hospital, but its rapid guideline on pneumonia and Covid-19 only says that ‘use of the NEWS2 tool in the community for predicting the risk of clinical deterioration may be useful’.
It adds that ‘a face-to-face consultation should not be arranged solely to calculate a NEWS2 score’.
The researchers concluded: ‘Enthusiasm for NEWS2 in the primary care management of Covid-19 may be premature. If used at all, this score should be used alongside a wider clinical assessment of the patient and in the context of changes over time.
‘Further research is needed on the use of NEWS/NEWS2 in primary care, and on the use of prognostic scores more generally in the context of Covid-19. It should also be remembered that not every sick patient has Covid-19.’
It comes as a study from the University of Bristol, which looked at the use of NEWS in general practice more generally, concluded that the scores could be useful in ensuring that the care of critically ill patients was escalated more quickly.
This comes as NHS England has advised GPs to use NEWS2 in assessing who needs urgent critical care since October last year.
Researchers assessed the impact of NEWS scores collected for more than 13,000 urgent GP referrals to hospital, in the first UK study to investigate the association between NEWS referral from primary care and clinical outcomes in secondary care.
The team found that higher scores are associated with faster transportation for patients travelling by ambulance, averaging at 94 minutes. This is compared with an average of 132 minutes travel time for those with the lowest NEWS scores. Patients with high scores were also seen for medical review more quickly once they had arrived at hospital. Patients were also sicker, with more ITU admissions and higher rates of sepsis.
This indicates that NEWS values recorded at referral into hospital are associated with poorer clinical outcomes, and the authors suggest that calculating scores at an earlier point in the patient pathway could help prioritise the sickest patients and improve patient outcomes.
The paper, published in the BJGP, said: ‘The findings should go some way to increase GPs’ trust in using NEWS (now NEWS2) to communicate patient acuity to ambulance and secondary care staff.
‘It should reassure GPs both locally and nationally that, when used in conjunction with clinical judgement, calculating NEWS in primary care is worthwhile in terms of its impact on improving clinical processes of assessment and treatment of their patients.’
But Dr Trefor Roscoe, medical information consultant and a GP in Sheffield, said: ‘I am not convinced that they have done anything [other] than show – which was known – that ill people have high NEWS scores.’
He added: Spending 10 to 15 minutes carefully measuring and recording a variety of numbers then calculating a score wastes time. I and my colleagues should be able to make a clinical decision much faster…
‘Trying to prove it is useful in primary care would involve a randomised trial where some patients had a NEWS score and some didn’t. An unethical study perhaps? Would not be good if the added admin delay affected outcomes.’