Dataset Information

Introducing the National Drug Early Warning System.

ABSTRACT:

Purpose of review

In 2013, NIH NIDA released a special funding opportunity to update and expand their longstanding Community Epidemiology Workgroup (CEWG) by creating a coordinating center for a new type of monitoring system that became the National Drug Early Warning System (NDEWS). This article provides an overview of four primary NDEWS components: core staff; an approach to detecting and monitoring emerging drug trends including community-based epidemiologists and national databases; small rapid follow-up studies; and innovative multimedia approaches for disseminating information.

Recent findings

The cornerstones for detecting and monitoring are the 1700+ member NDEWS Network and a coalition of local epidemiologists. Follow-up studies are designed with local researchers, practitioners, and policymakers to focus on local trends. Among NDEWS accomplishments are developing protocols for expanded urinalyses in high-risk populations and conducting follow-up studies with local collaborators in New Hampshire, New York, Ohio, Oregon, and a tribal nation in Minnesota.

Summary

During its first 6 years, NDEWS has advanced its mission to develop multidisciplinary collaborations and innovative technologies for identifying, monitoring, and following up on emerging drug trends and has contributed to the translation of science into practice. VIDEO ABSTRACT: http://links.lww.com/YCO/A55.

SUBMITTER: Artigiani EE

PROVIDER: S-EPMC7386464 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:We sought to validate prognostic scores in coronavirus disease 2019 including National Early Warning Score, Modified Early Warning Score, and age-based modifications, and define their performance characteristics.DesignWe analyzed prospectively collected data from the Adaptive COVID-19 Treatment Trial. National Early Warning Score was collected daily during the trial, Modified Early Warning Score was calculated, and age applied to both scores. We assessed prognostic value for the end points of recovery, mechanical ventilation, and death for score at enrollment, average, and slope of score over the first 48 hours.SettingA multisite international inpatient trial.PatientsA total of 1,062 adult nonpregnant inpatients with severe coronavirus disease 2019 pneumonia.InterventionsAdaptive COVID-19 Treatment Trial 1 randomized participants to receive remdesivir or placebo. The prognostic value of predictive scores was evaluated in both groups separately to assess for differential performance in the setting of remdesivir treatment.Measurements and main resultsFor mortality, baseline National Early Warning Score and Modified Early Warning Score were weakly to moderately prognostic (c-index, 0.60-0.68), and improved with addition of age (c-index, 0.66-0.74). For recovery, baseline National Early Warning Score and Modified Early Warning Score demonstrated somewhat better prognostic ability (c-index, 0.65-0.69); however, National Early Warning Score+age and Modified Early Warning Score+age further improved performance (c-index, 0.68-0.71). For deterioration, baseline National Early Warning Score and Modified Early Warning Score were weakly to moderately prognostic (c-index, 0.59-0.69) and improved with addition of age (c-index, 0.63-0.70). All prognostic performance improvements due to addition of age were significant (p < 0.05).ConclusionsIn the Adaptive COVID-19 Treatment Trial 1 cohort, National Early Warning Score and Modified Early Warning Score demonstrated moderate prognostic performance in patients with severe coronavirus disease 2019, with improvement in predictive ability for National Early Warning Score+age and Modified Early Warning Score+age. Area under receiver operating curve for National Early Warning Score and Modified Early Warning Score improved in patients receiving remdesivir versus placebo early in the pandemic for recovery and mortality. Although these scores are simple and readily obtainable in myriad settings, in our data set, they were insufficiently predictive to completely replace clinical judgment in coronavirus disease 2019 and may serve best as an adjunct to triage, disposition, and resourcing decisions.