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Prognostic accuracy of emergency department triage tools for adults with suspected COVID-19: the PRIEST observational cohort study.
- Source :
-
Emergency medicine journal : EMJ [Emerg Med J] 2021 Aug; Vol. 38 (8), pp. 587-593. Date of Electronic Publication: 2021 Jun 03. - Publication Year :
- 2021
-
Abstract
- Background: The WHO and National Institute for Health and Care Excellence recommend various triage tools to assist decision-making for patients with suspected COVID-19. We aimed to compare the accuracy of triage tools for predicting severe illness in adults presenting to the ED with suspected COVID-19.<br />Methods: We undertook a mixed prospective and retrospective observational cohort study in 70 EDs across the UK. We collected data from people attending with suspected COVID-19 and used presenting data to determine the results of assessment with the WHO algorithm, National Early Warning Score version 2 (NEWS2), CURB-65, CRB-65, Pandemic Modified Early Warning Score (PMEWS) and the swine flu adult hospital pathway (SFAHP). We used 30-day outcome data (death or receipt of respiratory, cardiovascular or renal support) to determine prognostic accuracy for adverse outcome.<br />Results: We analysed data from 20 891 adults, of whom 4611 (22.1%) died or received organ support (primary outcome), with 2058 (9.9%) receiving organ support and 2553 (12.2%) dying without organ support (secondary outcomes). C-statistics for the primary outcome were: CURB-65 0.75; CRB-65 0.70; PMEWS 0.77; NEWS2 (score) 0.77; NEWS2 (rule) 0.69; SFAHP (6-point rule) 0.70; SFAHP (7-point rule) 0.68; WHO algorithm 0.61. All triage tools showed worse prediction for receipt of organ support and better prediction for death without organ support. At the recommended threshold, PMEWS and the WHO criteria showed good sensitivity (0.97 and 0.95, respectively) at the expense of specificity (0.30 and 0.27, respectively). The NEWS2 score showed similar sensitivity (0.96) and specificity (0.28) when a lower threshold than recommended was used.<br />Conclusion: CURB-65, PMEWS and the NEWS2 score provide good but not excellent prediction for adverse outcome in suspected COVID-19, and predicted death without organ support better than receipt of organ support. PMEWS, the WHO criteria and NEWS2 (using a lower threshold than usually recommended) provide good sensitivity at the expense of specificity.<br />Trial Registration Number: ISRCTN56149622.<br />Competing Interests: Competing interests: None declared.<br /> (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Subjects :
- Aged
COVID-19 epidemiology
Early Warning Score
Female
Humans
Male
Middle Aged
Pandemics
Pneumonia, Viral epidemiology
Pneumonia, Viral virology
Predictive Value of Tests
Prognosis
Prospective Studies
Retrospective Studies
SARS-CoV-2
United Kingdom
COVID-19 therapy
Emergency Service, Hospital
Pneumonia, Viral therapy
Triage methods
Subjects
Details
- Language :
- English
- ISSN :
- 1472-0213
- Volume :
- 38
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Emergency medicine journal : EMJ
- Publication Type :
- Academic Journal
- Accession number :
- 34083427
- Full Text :
- https://doi.org/10.1136/emermed-2020-210783