Modified National Early Warning Score as Early Predictor of Outcome in COVID-19 Pandemic.

COVID-19 represented an important challenge to the Italian healthcare system (IHCS). Our main aim was to obtain evidence to support the use of modified national early warning score (m-NEWS) as an interdisciplinary, common, and universal scoring scale to quickly recognize patients with a risk of clinical deterioration before admission and during hospitalization. As a secondary goal, we tried to find a score threshold that can trigger patients' immediate medical review as a part of an optimal triaging protocol for an emergency setting where healthcare resources are overloaded. We performed a retrospective observational study. We included in our study all patients treated for COVID-19 infection in surgical departments between 01 March 2020 and 16 April 2020. Patients with negative test results for SARS-COV-2 were excluded. m-NEWS was obtained twice a day. Patients' m-NEWS were analyzed in order to verify the correlation between m-NEWS (at admission and m-NEWS variation 24 h after admission) and outcome (positive outcome-survival, negative outcome-death, or intensive care unit (ICU) transfer). We included a population-based sample of 225 SARS-COV-2-infected patients. Overall, the average age at hospitalization was 71 (ranging from 40 to 95). 144 (64%) patients were males and 81 (36%) females. m-NEWS values lower or equal to 7 were associated with the majority of the "recovered" population (100/132 75.75%) and at the same time with the minority of the "non-recovered" population (25/93 26.88%). For our sample, age is statistically correlated to the outcome but a triage protocol based solely on this variable is less effective than m-NEWS, which showed to be a reliable and easy-to-use score for first patient evaluation. Our observations pave the way towards further studies aiming at optimizing territorial and community healthcare management protocols.

The Modified National Early Warning Score (m-NEWS) for COVID-19-Infected Patient Evaluation: a Proof-of-Concept.

The second wave of Sars CoV 2 pandemic in Italy still represents an important concern for the Italian health system (IHS). Despite the experience gained during the first phase of the pandemic in January 2020, COVID-19 patients are still arising, putting on a strain resources of local authorities and emergency services. The aim of this research project is to analyze the feasibility of using the modified National Early Warning Score (m-NEWS) as a way to rapidly identify COVID-19-infected patient with high risk of clinical deterioration, helping the clinical pre-evaluation in a moment of overwhelming request for the Italian out-of-hospital emergency system (Perlini et al., Intern Emerg Med 15(5):825-833, 2020) as during the initial coronavirus outbreak.

Re-reading the SARS-COV-2 Epidemic in Bergamo.

Bergamo province was one of the hardest hit regions by the novel SARS-CoV-2 virus. Since the beginning of the epidemic, more than 30,000 people have died as a result of the infection. Although many hypotheses have been formulated to explain the rapid outbreak of COVID-19 in Lombardy, none have yet considered the specific conditions that characterized the Bergamo hinterland. In this letter, we try to identify and investigate which elements could have helped the rapid spreading of the virus.

Total hip arthroplasty planning.

Preoperative planning is mandatory to achieve the restoration of a correct and personalized biomechanics of the hip.The radiographic review is the first and fundamental step in the planning. Limb or pelvis malpositioning during the review results in mislead planning.Correct templating is possible using three different methods: acetate templating on digital X-ray, digital 2D templating on digital X-ray and 3D digital templating on CT scan.Time efficiency, costs, reproducibility and accuracy must be considered when comparing different templating methods. Based on these parameters, acetate templating should not be abandoned; digital templating allows a permanent record of planning and can be electronically viewed by different members of surgical team; 3D templating is intrinsically more accurate. There is no evidence in the few recently published studies that 3D templating impacts positively on clinical outcomes except in difficult cases.The transverse acetabular ligament (TAL) is a reliable intraoperative soft tissue reference to set cup position.Spine-hip relations in osteoarthritic patients undergoing hip joint replacement must be considered. Cite this article: EFORT Open Rev 2019;4:626-632. DOI: 10.1302/2058-5241.4.180075.