CC BY-NC-ND 4.0 · Ibnosina Journal of Medicine and Biomedical Sciences 2024; 16(02): 057-067
DOI: 10.1055/s-0044-1782615
Original Article

The Effect of Implementation of the National Early Warning Scoring System 2 on the Outcomes of COVID-19 Hospitalized Patients

1   An-Najah National University Faculty of Nursing, Nablus, Palestine
2   Master of Science in Nursing in Critical Care Nursing, Critical Care Registered Nurse, Rafedia Surgical Governmental Hospital, Palestinian Ministry of Health, Nablus, Palestine
› Author Affiliations
Funding None.


Introduction It is crucial to have tools to predict the clinical deterioration of coronavirus disease 2019 (COVID-19) patients. We aimed to study the efficacy of the National Early Warning Scoring System (NEWS2) application in predicting the risk of clinical relapse and outcomes in hospitalized COVID-19 patients at Palestinian specialized centers for COVID-19.

Patients and Methods A quasi-experimental design was applied. A sample of 384 adult patients was divided into two groups. For the pre-NEWS phase (control group) and the post-NEWS phase (study group), all study participants were observed until death or hospital discharge.

Results Comparing the pre-NEWS phase with the post-NEWS phase, a significant decrease was found in the mean length of hospital stay from 8.1 ± 5.5 to 6.4 ± 5.3 days (p = 0.002) and a reduction in the mortality rate from 19.8% during the pre-NEWS phase to 12.5% during the post-NEWS phase (p = 0.071). The predictive value of NEWS was an excellent predictor of admission to the intensive care unit (ICU), as indicated by an area under the receiver operating characteristic curve of 0.91 (95% confidence interval: 0.87–0.96, p < 0.001). Also, a significant difference in the frequency of monitoring patients' vital signs was observed between the control group (pre-NEWS phase) and the study group (post-NEWS phase) following clinical deterioration (10.1 ± 7.8 [pre-NEWS phase] vs. 23.4 ± 0.7 [post-NEWS phase], p < 0.001).

Conclusion Implementation of NEWS2 showed a significant improvement in hospitalized COVID-19 patient outcomes (length of stay, predicted ICU admissions, mortality rate, and frequency of vital signs measurements), which indirectly raised the follow-up of those patients by the medical team and attributed to a significant prediction of their deterioration.

Authors' Contribution

I.M.T. and J.Q. contributed to literature search, preparation of the manuscript, and revision of the manuscript along with this they also initiated, conceptualized, designed, and organized the research, supervised and critically reviewed the manuscript and finalized the manuscript. All authors approved the final manuscript.

Ethical Approval

An Institutional Review Board approval was granted by the An-Najah National University Research Committee (March 2022/25). Informed consent was obtained from all participants before being enrolled. Ethics approval and consent to participate in this study were carried out in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Institutional Review Board of An-Najah National University and was also obtained for all participants who participated in the study. Instructions and voluntary participation statements were included. All data collected were confidential and used only for this study.

Availability of Data

The data sets used for the current study are available from the corresponding author upon reasonable requests.

Publication History

Article published online:
08 May 2024

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