Dataset Information

Performance of point-of-care severity scores to predict prognosis in patients admitted through the emergency department with COVID-19.

ABSTRACT:

Background

Identifying COVID-19 patients at the highest risk of poor outcomes is critical in emergency department (ED) presentation. Sepsis risk stratification scores can be calculated quickly for COVID-19 patients but have not been evaluated in a large cohort.

Objective

To determine whether well-known risk scores can predict poor outcomes among hospitalized COVID-19 patients.

Designs, settings, and participants

A retrospective cohort study of adults presenting with COVID-19 to 156 Hospital Corporation of America (HCA) Healthcare EDs, March 2, 2020, to February 11, 2021.

Intervention

Quick Sequential Organ Failure Assessment (qSOFA), Shock Index, National Early Warning System-2 (NEWS2), and quick COVID-19 Severity Index (qCSI) at presentation.

Main outcome and measures

The primary outcome was in-hospital mortality. Secondary outcomes included intensive care unit (ICU) admission, mechanical ventilation, and vasopressors receipt. Patients scored positive with qSOFA ≥ 2, Shock Index > 0.7, NEWS2 ≥ 5, and qCSI ≥ 4. Test characteristics and area under the receiver operating characteristics curves (AUROCs) were calculated.

Results

We identified 90,376 patients with community-acquired COVID-19 (mean age 64.3 years, 46.8% female). 17.2% of patients died in-hospital, 28.6% went to the ICU, 13.7% received mechanical ventilation, and 13.6% received vasopressors. There were 3.8% qSOFA-positive, 45.1% Shock Index-positive, 49.8% NEWS2-positive, and 37.6% qCSI-positive at ED-triage. NEWS2 exhibited the highest AUROC for in-hospital mortality (0.593, confidence interval [CI]: 0.588-0.597), ICU admission (0.602, CI: 0.599-0.606), mechanical ventilation (0.614, CI: 0.610-0.619), and vasopressor receipt (0.600, CI: 0.595-0.604).

Conclusions

Sepsis severity scores at presentation have low discriminative power to predict outcomes in COVID-19 patients and are not reliable for clinical use. Severity scores should be developed using features that accurately predict poor outcomes among COVID-19 patients to develop more effective risk-based triage.

SUBMITTER: Prasad PA

PROVIDER: S-EPMC11344580 | biostudies-literature | 2023 May

REPOSITORIES: biostudies-literature

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Publications

Performance of point-of-care severity scores to predict prognosis in patients admitted through the emergency department with COVID-19.

Prasad Priya A PA Correia Jessica J Fang Margaret C MC Fisher Arielle A Correll Mick M Oreper Sandra S Auerbach Andrew A

Journal of hospital medicine 20230414 5

<h4>Background</h4>Identifying COVID-19 patients at the highest risk of poor outcomes is critical in emergency department (ED) presentation. Sepsis risk stratification scores can be calculated quickly for COVID-19 patients but have not been evaluated in a large cohort.<h4>Objective</h4>To determine whether well-known risk scores can predict poor outcomes among hospitalized COVID-19 patients.<h4>Designs, settings, and participants</h4>A retrospective cohort study of adults presenting with COVID-1 ...[more]

PMID: 37057912

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Project description:ObjectivePaediatric Early Warning Scores (PEWS) are widely used in the UK, but the heterogeneity across tools and the limited data on their predictive performance represent obstacles to improving best practice. The standardisation of practice through the proposed National PEWS will rely on robust validation. Therefore, we compared the performance of the National PEWS with six other PEWS currently used in NHS hospitals, for their ability to predict critical care (CC) admission in febrile children attending the emergency department (ED).DesignRetrospective single-centre cohort study.SettingTertiary hospital paediatric ED.ParticipantsA total of 11 449 eligible febrile ED attendances were identified from the electronic patient record over a 2-year period. Seven PEWS scores were calculated (Alder Hey, Bedside, Bristol, National, Newcastle and Scotland PEWS, and the Paediatric Observation Priority Score, using the worst observations recorded during their ED stay.OutcomesThe primary outcome was CC admission within 48 hours, the secondary outcomes were hospital length of stay (LOS) >48 hours and sepsis-related mortality.ResultsOf 11 449 febrile children, 134 (1.2%) were admitted to CC within 48 hours of ED presentation, 606 (5.3%) had a hospital LOS >48 hours. 10 (0.09%) children died, 5 (0.04%) were sepsis-related. All seven PEWS demonstrated excellent discrimination for CC admission (range area under the receiver operating characteristic curves (AUC) 0.91-0.95) and sepsis-related mortality (range AUC 0.95-0.99), most demonstrated moderate discrimination for hospital LOS (range AUC 0.69-0.75). In CC admission threshold analyses, bedside PEWS (AUC 0.90; 95% CI 0.86 to 0.93) and National PEWS (AUC 0.90; 0.87-0.93) were the most discriminative, both at a threshold of ≥6.ConclusionsOur results support the use of the proposed National PEWS in the paediatric ED for the recognition of suspected sepsis to improve outcomes, but further validation is required in other settings and presentations.

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Dataset Information

Performance of point-of-care severity scores to predict prognosis in patients admitted through the emergency department with COVID-19.

Background

Objective

Designs, settings, and participants

Intervention

Main outcome and measures

Results

Conclusions

Publications

Performance of point-of-care severity scores to predict prognosis in patients admitted through the emergency department with COVID-19.

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