Comparison of Coronavirus Disease Severity Using National Early Warning Score in Vaccinated versus Unvaccinated Patients Against COVID-19 Presenting to the Emergency Department
DOI:
https://doi.org/10.54112/bcsrj.v6i1.1598Keywords:
COVID-19; Coronavirus Infections; Emergency Service, Hospital; National Early Warning Score; Severity of Illness Index; VaccinationAbstract
Coronavirus disease severity varies widely at presentation, and early risk stratification in emergency settings is essential for timely management. The National Early Warning Score is a validated tool for assessing clinical deterioration. Objective: To determine coronavirus disease severity using the National Early Warning Score and to compare disease severity between vaccinated and unvaccinated patients presenting to the emergency department. Methods: This descriptive cross-sectional study was conducted at the Emergency Department of Shifa International Hospital, Islamabad. A total of 95 laboratory-confirmed patients with coronavirus disease presenting to the emergency department were enrolled. Patients were categorised into two groups: fully vaccinated against coronavirus disease and unvaccinated. Vaccination status was verified through patient or family confirmation using the NADRA coronavirus disease vaccination certificate. National Early Warning Score values and demographic and clinical variables were recorded. Data were analysed using SPSS, and comparisons between groups were performed, with p-values of 0.05 or less considered statistically significant. Results: The mean age of the participants was 60.78 ± 16.97 years, with 54 patients aged between 50 and 75 years. Males comprised 57.9 percent of the study population. The overall mean National Early Warning Score was 4.55 ± 3.04. Low, moderate, and high risk scores were observed in 49.5 percent, 27.4 percent, and 23.2 percent of patients, respectively. Vaccinated individuals constituted 73.7 percent of the cohort. The mean National Early Warning Score was significantly lower in vaccinated patients compared to unvaccinated patients (3.53 ± 2.62 vs 7.40 ± 2.22, p < 0.0001). High risk scores were observed in 64 percent of unvaccinated patients compared to 8.6 percent of vaccinated patients, demonstrating a highly significant association (p < 0.0001). Conclusion: Unvaccinated patients presenting with coronavirus disease have a significantly higher risk of severe illness compared to vaccinated patients. Vaccination is strongly associated with reduced disease severity as assessed by the National Early Warning Score.
Downloads
References
Bahl A, Johnson S, Maine G, Garcia MH, Nimmagadda S, Qu L, et al. Vaccination reduces need for emergency care in breakthrough COVID-19 infections: a multicenter cohort study. Lancet Reg Health Am. 2021;4:100065. https://doi.org/10.1016/j.lana.2021.100065
World Health Organization. COVID-19 epidemiological update. 24 Dec 2024 [cited 2025 Dec 30]. Available from: https://www.who.int/publications/m/item/covid-19-epidemiological-update---24-december-2024
Worldometer. Pakistan: Coronavirus cases (COVID-19). 2024 [cited 2025 Dec 30]. Available from: https://www.worldometers.info/coronavirus/country/pakistan/
Antonelli M, Penfold RS, Merino J, Sudre CH, Molteni E, Berry S, et al. Risk factors and disease profile of post-vaccination SARS-CoV-2 infection in UK users of the COVID Symptom Study app: a prospective, community-based, nested, case-control study. Lancet Infect Dis. 2022;22(1):43-55. https://doi.org/10.1016/S1473-3099(21)00460-6
Egan C, Knight S, Baillie K, Harrison E, Docherty A, Semple C. Hospitalised vaccinated patients during the second wave, update April 2021. ISARIC4C Consortium COVID-19 Clinical Information Network (CO-CIN); 2021.
Bradley P, Frost F, Tharmaratnam K, Wootton DG. Utility of established prognostic scores in COVID-19 hospital admissions: multicentre prospective evaluation of CURB-65, NEWS2 and qSOFA. BMJ Open Respir Res. 2020;7(1):e000729. https://doi.org/10.1136/bmjresp-2020-000729
Wynants L, Van Calster B, Collins GS, Riley RD, Heinze G, Schuit E, et al. Prediction models for Diagnosis and prognosis of COVID-19: systematic review and critical appraisal. BMJ. 2020;369:m1328. https://doi.org/10.1136/bmj.m1328
Ghaderi H, Stowell JR, Akhter M, Norquist C, Pugsley P, Subbian V. Impact of COVID-19 pandemic on emergency department visits: a regional case study of informatics challenges and opportunities. AMIA Annu Symp Proc. 2021;2021:496-505.
Pantazopoulos I, Tsikrika S, Kolokytha S, Manos E, Porpodis K. Management of COVID-19 patients in the emergency department. J Pers Med. 2021;11(10):961. https://doi.org/10.3390/jpm11100961
Reschen ME, Bowen J, Novak A, Giles M, Singh S, Lasserson D, et al. Impact of the COVID-19 pandemic on emergency department attendances and acute medical admissions. BMC Emerg Med. 2021;21(1):143. https://doi.org/10.1186/s12873-021-00529-w
Park SY, Youn CS, Kim HJ, Kim SH, Park SH, Bang HJ. Application of the National Early Warning Score in patients with suspected COVID-19 in Korea. Hong Kong J Emerg Med. 2024;31(2):76-83. https://doi.org/10.1002/hkj2.12016
Martín-Rodríguez F, Martín-Conty JL, Sanz-García A, Rodríguez VC, Rabbione GO, Cebrián-Ruíz I, et al. Early warning scores in patients with suspected COVID-19 infection in emergency departments. J Pers Med. 2021;11(3):170. https://doi.org/10.3390/jpm11030170
Randolph HE, Barreiro LB. Herd immunity: understanding COVID-19. Immunity. 2020;52(5):737-741. https://doi.org/10.1016/j.immuni.2020.04.012
Harvey BW, Kelleran KJ, Suffoletto H, Ma C, Nan N, Penque MD, et al. Emergency department patients' COVID-19 vaccination status and self-reported barriers. West J Emerg Med. 2022;23(3):292-301.
Fernández-Penny FE, Jolkovsky EL, Shofer FS, Hemmert KC, Valiuddin H, Uspal JE, et al. COVID-19 vaccine hesitancy among patients in two urban emergency departments. Acad Emerg Med. 2021;28(10):1100-1107. https://doi.org/10.1111/acem.14376
Rodriguez RM, Torres JR, Chang AM, Haggins AN, Eucker SA, O'Laughlin KN, et al. The rapid evaluation of COVID-19 vaccination in emergency departments for underserved patients study. Ann Emerg Med. 2021;78(4):502-510. https://doi.org/10.1016/j.annemergmed.2021.03.018
Menni C, Klaser K, May A, Polidori L, Capdevila J, Louca P, et al. Vaccine side-effects and SARS-CoV-2 infection after vaccination in users of the COVID Symptom Study app in the UK: a prospective observational study. Lancet Infect Dis. 2021;21(7):939-949. https://doi.org/10.1016/S1473-3099(21)00224-3
Haas EJ, Angulo FJ, McLaughlin JM, Anis E, Singer SR, Khan F, et al. Impact and effectiveness of mRNA BNT162b2 vaccine against SARS-CoV-2 infections and COVID-19 cases, hospitalisations, and deaths following a nationwide vaccination campaign in Israel: an observational study using national surveillance data. Lancet. 2021;397(10287):1819-1829. https://doi.org/10.1016/S0140-6736(21)00947-8
Khandker SS, Godman B, Jawad MI, Meghla BA, Tisha TA, Khondoker MU, et al. A systematic review on COVID-19 vaccine strategies, their effectiveness, and issues. Vaccines (Basel). 2021;9(12):1387. https://doi.org/10.3390/vaccines9121387
Pritchard E, Matthews PC, Stoesser N, Eyre DW, Gethings O, Vihta KD, et al. Impact of vaccination on new SARS-CoV-2 infections in the United Kingdom. Nat Med. 2021;27(8):1370-1378. https://doi.org/10.1038/s41591-021-01410-w
Tenforde MW, Patel MM, Ginde AA, Douin DJ, Talbot HK, Casey JD, et al. Effectiveness of severe acute respiratory syndrome coronavirus 2 messenger RNA vaccines for preventing coronavirus
disease 2019 hospitalizations in the United States. Clin Infect Dis. 2022;74(9):1515-1524. https://doi.org/10.1093/cid/ciab687
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Alisha Inayat, Abdus Salam Khan, Assad Kamal Sheikh, Maheen Asim

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.


