Performance of Point-of-care Severity Scores to Predict Prognosis in Patients Admitted Through the Emergency Department with COVID-19

Overview

Journal J Hosp Med

Publisher Wiley

Specialties General Medicine
Health Services

Date 2023 Apr 14

PMID 37057912

Authors

Priya A Prasad

Jessica Correia

Margaret C Fang

Arielle Fisher

Mick Correll

Sandra Oreper

Andrew Auerbach

Affiliations

Soon will be listed here.

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.

Citing Articles

ANCOC Score to Predict Mortality in Different SARS-CoV-2 Variants and Vaccination Status.

Candelli M, Sacco Fernandez M, Pignataro G, Merra G, Tullo G, Bronzino A J Clin Med. 2023; 12(18).

PMID: 37762779 PMC: 10532001. DOI: 10.3390/jcm12185838.

References

Haimovich A, Ravindra N, Stoytchev S, Young H, Wilson F, van Dijk D . Development and Validation of the Quick COVID-19 Severity Index: A Prognostic Tool for Early Clinical Decompensation. Ann Emerg Med. 2020; 76(4):442-453. PMC: 7373004. DOI: 10.1016/j.annemergmed.2020.07.022. View

Singer M, Deutschman C, Seymour C, Shankar-Hari M, Annane D, Bauer M . The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):801-10. PMC: 4968574. DOI: 10.1001/jama.2016.0287. View

Prasad P, Fang M, Martinez S, Liu K, Kangelaris K . Identifying the Sickest During Triage: Using Point-of-Care Severity Scores to Predict Prognosis in Emergency Department Patients With Suspected Sepsis. J Hosp Med. 2021; 16(8):453-461. PMC: 8340957. DOI: 10.12788/jhm.3642. View

Harish K, Zhang B, Stella P, Hauck K, Moussa M, Adler N . Validation of parsimonious prognostic models for patients infected with COVID-19. BMJ Health Care Inform. 2021; 28(1). PMC: 8421114. DOI: 10.1136/bmjhci-2020-100267. View

Goldberg E, Southerland L, Meltzer A, Pagenhardt J, Hoopes R, Camargo Jr C . Age-related differences in symptoms in older emergency department patients with COVID-19: Prevalence and outcomes in a multicenter cohort. J Am Geriatr Soc. 2022; 70(7):1918-1930. PMC: 9115070. DOI: 10.1111/jgs.17816. View

Usman O, Usman A, Ward M . Comparison of SIRS, qSOFA, and NEWS for the early identification of sepsis in the Emergency Department. Am J Emerg Med. 2018; 37(8):1490-1497. DOI: 10.1016/j.ajem.2018.10.058. View

Wagner T, Sinning C, Haumann J, Magnussen C, Blankenberg S, Reichenspurner H . qSOFA Score Is Useful to Assess Disease Severity in Patients With Heart Failure in the Setting of a Heart Failure Unit (HFU). Front Cardiovasc Med. 2020; 7:574768. PMC: 7655543. DOI: 10.3389/fcvm.2020.574768. View

Covino M, Sandroni C, Santoro M, Sabia L, Simeoni B, Bocci M . Predicting intensive care unit admission and death for COVID-19 patients in the emergency department using early warning scores. Resuscitation. 2020; 156:84-91. PMC: 7480278. DOI: 10.1016/j.resuscitation.2020.08.124. View

Petersen J, Jhala D . Practical Risk Scoring System for Predicting Severity of COVID-19 Disease. Clin Pathol. 2022; 15:2632010X211068427. PMC: 8744169. DOI: 10.1177/2632010X211068427. View

10.

Goulden R, Hoyle M, Monis J, Railton D, Riley V, Martin P . qSOFA, SIRS and NEWS for predicting inhospital mortality and ICU admission in emergency admissions treated as sepsis. Emerg Med J. 2018; 35(6):345-349. DOI: 10.1136/emermed-2017-207120. View

11.

Piva S, Filippini M, Turla F, Cattaneo S, Margola A, De Fulviis S . Clinical presentation and initial management critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Brescia, Italy. J Crit Care. 2020; 58:29-33. PMC: 7194649. DOI: 10.1016/j.jcrc.2020.04.004. View

12.

Abdullah S, Sorensen R, Dessau R, Sattar S, Wiese L, Nielsen F . Prognostic accuracy of qSOFA in predicting 28-day mortality among infected patients in an emergency department: a prospective validation study. Emerg Med J. 2019; 36(12):722-728. DOI: 10.1136/emermed-2019-208456. View

13.

Cr P, Vanidassane I, Pownraj D, Kandasamy R, Basheer A . National Early Warning Score 2 (NEWS2) to predict poor outcome in hospitalised COVID-19 patients in India. PLoS One. 2021; 16(12):e0261376. PMC: 8673675. DOI: 10.1371/journal.pone.0261376. View

14.

van Walraven C, Austin P, Jennings A, Quan H, Forster A . A modification of the Elixhauser comorbidity measures into a point system for hospital death using administrative data. Med Care. 2009; 47(6):626-33. DOI: 10.1097/MLR.0b013e31819432e5. View

15.

Berger T, Green J, Horeczko T, Hagar Y, Garg N, Suarez A . Shock index and early recognition of sepsis in the emergency department: pilot study. West J Emerg Med. 2013; 14(2):168-74. PMC: 3628475. DOI: 10.5811/westjem.2012.8.11546. View

16.

Jouffroy R, Brami E, Scannavino M, Daniel Y, Bertho K, Abriat A . Association between prehospital shock index and mortality among patients with COVID-19 disease. Am J Emerg Med. 2022; 56:133-136. PMC: 8970620. DOI: 10.1016/j.ajem.2022.03.059. View

17.

Soto-Mota A, Marfil-Garza B, Castiello-de Obeso S, Martinez Rodriguez E, Carrillo Vazquez D, Tadeo-Espinoza H . Prospective predictive performance comparison between clinical gestalt and validated COVID-19 mortality scores. J Investig Med. 2021; 70(2):415-420. DOI: 10.1136/jim-2021-002037. View

18.

Kim K, Suh G, Kim K, Kwon W, Shin J, Jo Y . Quick Sepsis-related Organ Failure Assessment score is not sensitive enough to predict 28-day mortality in emergency department patients with sepsis: a retrospective review. Clin Exp Emerg Med. 2019; 6(1):77-83. PMC: 6453684. DOI: 10.15441/ceem.17.294. View

19.

Chikhalkar B, Gosain D, Gaikwad S, Deshmukh R . Assessment of National Early Warning Score 2 as a Tool to Predict the Outcome of COVID-19 Patients on Admission. Cureus. 2022; 14(1):e21164. PMC: 8831360. DOI: 10.7759/cureus.21164. View

20.

Sam A, Sanchez D, Gomez V, Wagner C, Kopecna D, Zamarro C . The shock index and the simplified PESI for identification of low-risk patients with acute pulmonary embolism. Eur Respir J. 2010; 37(4):762-6. DOI: 10.1183/09031936.00070110. View