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Objective: To compare the performance of established scoring systems (CURB65, NEWS2, qSOFA, SOFA and REDS) to the newly developed scores (ISARIC 4C, PRIEST and novel COVID-19 severity scores) in mortality prediction for patients with confirmed COVID-19 infection in the emergency department (ED). Method: A retrospective observational cohort study of adult patients attending a teaching hospital ED who fulfilled the criteria for suspected sepsis and tested positive for COVID-19. The scores were calculated for each patient. The primary outcome measure was all-cause in-hospital mortality. Receiver operator characteristic (ROC) curves were generated for each score. The area under the ROC (AUROC) curves were compared to that of the ISARIC 4C score. The cut-off points were determined by the statistical software package. The test characteristics at the cut-off scores were noted. Results: Of the 504 patients studied, 153 (30.5%) died in hospital. The AUROC of the ISARIC 4C score was similar to all of the scores except for the NEWS2 score and qSOFA scores, which were significantly lower. The test characteristics of the different scores were similar. Conclusions: In this single-centre study, the newly developed COVID scores outperformed the NEWS2 and qSOFA scores but did not perform better than the other scores studied.

BackgroundPatients admitted to hospital with sepsis are at persistent risk of poor outcome after discharge. Many tools are available to risk-stratify sepsis patients for in-hospital mortality. This study aimed to identify the best risk-stratification tool to prognosticate outcome 180 days after admission via the emergency department (ED) with suspected sepsis.MethodsA retrospective observational cohort study was performed of adult ED patients who were admitted after receiving intravenous antibiotics for the treatment of a suspected sepsis, between 1st March and 31st August 2019. The Risk-stratification of ED suspected Sepsis (REDS) score, SOFA score, Red-flag sepsis criteria met, NICE high-risk criteria met, the NEWS2 score and the SIRS criteria, were calculated for each patient. Death and survival at 180 days were noted. Patients were stratified in to high and low-risk groups as per accepted criteria for each risk-stratification tool. Kaplan–Meier curves were plotted for each tool and the log-rank test performed. The tools were compared using Cox-proportional hazard regression (CPHR). The tools were studied further in those without the following specified co-morbidities: Dementia, malignancy, Rockwood Frailty score of 6 or more, long-term oxygen therapy and previous do-not-resuscitate orders.ResultsOf the 1,057 patients studied 146 (13.8%) died at hospital discharge and 284 were known to have died within 180 days. Overall survival proportion was 74.4% at 180 days and 8.6% of the population was censored before 180 days. Only the REDS and SOFA scores identified less than 50% of the population as high-risk. All tools except the SIRS criteria, prognosticated for outcome at 180 days; Log-rank tests between high and low-risk groups were: REDS score p