Utilização da Ferramenta de Avaliação do Nível de Deterioração Precoce (NEWS) em pacientes com covid-19 e a intervenção da equipe fisioterapêutica em um hospital campanha da Paraíba

Abstract

Introduction: Covid-19 is an infectious disease, with inflammatory repercussions in various organs and of varying degrees. In the severe form, it affects the respiratory system severely, causing it to progress to respiratory distress syndrome, rapidly altering the physiological signs, which when identified late, increases the risk of cardiorespiratory arrest, hospitalization in ICU and death, and inadequacy of therapy. Early clinical deterioration systems in hospitalized patients based on physiological parameters are widely used to predict intubation, ICU admission and death, but there is a lack of literature on risk stratification related to inhospital physical therapy interventions. Aim: The primary objective is to evaluate the predictive capacity of the National Early Warning Score (NEWS) for stratification of severity risk at admission of patients diagnosed with covid-19, in addition to analyzing the physiotherapeutic clinical decision-making based on this score. Materials and Methods: This is a cross-sectional, retrospective, analytical and exploratory study of data from medical records of inpatients at Hospital Solidário from June to October 2020. The sample was nonprobabilistic and for convenience, composed of data of physical/electronic medical records of patients, being filtered by inclusion and exclusion criteria. Data collection consisted of a form of data collected by accessing the electronic medical record system (TiMed). The statistical strategy was performed in three stages, with normality assessment using the KolmogorovSmirnov test, followed by descriptive analysis, expressing frequency data, and, finally, inferential analysis was performed with correlations using the Spearman test between risk stratifications. and referral to the ICU and associations by binary logistic regressions among the other variables. Results: 195 admissions records were identified with NEWS score evaluation, however, 21 patients were excluded from the results because they had COPD in their clinical diagnosis, thus resulting in 174 patient records, with a mean age of 62 years (62.75± 17 ,33), 59.9% men, SAH (39%) and cardiovascular diseases (8.9%) were the most common antecedents, according to NEWS, 30.5 and 26.4% of patients had medium and high risk, respectively, respiratory rate and peripheral oxygen saturation were the most affected signs. NEWS was positively associated with the introduction of oxygen therapy (p=0,035) and non-invasive ventilation (p=0,042) by the physical therapy team in low-risk patients. Conclusion: the NEWS early warning score applied to COVID-19 was able to define a gradual risk of deterioration based on vital signs and that is associated with different physiotherapy routines and mainly the low risk is related to oxygen therapy. NEWS can be an ally in physical therapy clinical decision-making.