Predicting intensive care unit admission and death for COVID-19 patients in the emergency department using early warning scores

RESUSCITATION

卷:156

Article

Covino, Marcello¹  Sandroni, Claudio^2,3  Santoro, Michele¹  Sabia, Luca¹  Simeoni, Benedetta¹  Bocci, Maria Grazia²  Ojetti, Veronica^1,4  Candelli, Marcello¹  Antonelli, Massimo^2,4  Gasbarrini, Antonio^4,5  Franceschi, Francesco^1,6 

[1] Fdn Policlin Univ A Gemelli, Emergency Dept, IRCCS, Rome, Italy

[2] Fdn Policlin Univ A Gemelli, Dept Intens Care Emergency Med & Anaesthesiol, IRCCS, Rome, Italy

[3] Univ Cattolica Sacro Cuore, Inst Anaesthesiol & Intens Care Med, Rome, Italy

[4] Fdn Policlin Univ A Gemelli, Dept Internal Med & Gastroenterol, IRCCS, Rome, Italy

[5] Univ Cattolica Sacro Cuore, Inst Internal Med & Gastroenterol, Rome, Italy

[6] Univ Cattolica Sacro Cuore, Inst Emergency Med, Rome, Italy

关键词: COVID-19;    Early warning scores;    MEWS;    NEWS;    NEWS2;    qSOFA;    REMS;   

DOI  :  10.1016/j.resuscitation.2020.08.124

来源: Elsevier

【 摘 要 】

Aims: To identify the most accurate early warning score (EWS) for predicting an adverse outcome in COVID-19 patients admitted to the emergency department (ED). Methods: In adult consecutive patients admitted (March 1-April 15, 2020) to the ED of a major referral centre for COVID-19, we retrospectively calculated NEWS, NEWS2, NEWS-C, MEWS, qSOFA, and REMS from physiological variables measured on arrival. Sensitivity, specificity, positive (PPV) and negative predictive value (NPV), and the area under the receiver operating characteristic (AUROC) curve of each EWS for predicting admission to the intensive care unit (ICU) and death at 48 h and 7 days were calculated. Results: We included 334 patients (119 [35.6%] females, median age 66 [54-78] years). At 7 days, the rates of ICU admission and death were 56/334 (17%) and 26/334 (7.8%), respectively. NEWS was the most accurate predictor of ICU admission within 7 days (AUROC 0.783 [95% CI, 0.735-0.826]; sensitivity 71.4 [57.8-82.7]%; NPV 93.1 [89.8-95.3]%), while REMS was the most accurate predictor of death within 7 days (AUROC 0.823 [0.778-0.863]; sensitivity 96.1 [80.4-99.9]%; NPV 99.4[96.2-99.9]%). Similar results were observed for ICU admission and death at 48 h. NEWS and REMS were as accurate as the triage system used in our ED. MEWS and qSOFA had the lowest overall accuracy for both outcomes. Conclusion: In our single-centre cohort of COVID-19 patients, NEWS and REMS measured on ED arrival were the most sensitive predictors of 7-day ICU admission or death. EWS could be useful to identify patients with low risk of clinical deterioration.

【 授权许可】

Free