Utility of ED triage tools in predicting the need for intensive respiratory or vasopressor support in adult patients with COVID-19

Serum and radiological parameters used to predict prognosis in COVID patients are not feasible in the Emergency Department. Due to its damaging effect on multiple organs and lungs, scores used to assess multiorgan damage and pneumonia such as Pandemic Medical Early Warning Score (PMEWS), National Ea...

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Published in:The American journal of emergency medicine 2024-04, Vol.78, p.151-156
Main Authors: Deva, Anandhi, Juthani, Ronit, Kugan, Ezhil, Balamurugan, N., Ayyan, Manu
Format: Article
Language:English
Subjects:
Adult
Antigens
COVID
COVID-19
Data collection
Diabetes
Diabetes mellitus
Emergency medical care
Emergency medical services
Emergency Service, Hospital
Hospital Mortality
Hospitalization
Hospitals
Humans
Hypertension
Kidney diseases
MEWS
Mortality
NEWS
Organ Dysfunction Scores
Pandemics
Patients
Pneumonia
Prognosis
Respiration
Retrospective Studies
ROC Curve
Sepsis - diagnosis
Statistical analysis
Triage
Ventilation
Ventilators
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Summary:Serum and radiological parameters used to predict prognosis in COVID patients are not feasible in the Emergency Department. Due to its damaging effect on multiple organs and lungs, scores used to assess multiorgan damage and pneumonia such as Pandemic Medical Early Warning Score (PMEWS), National Early Warning Score 2 (NEWS2), WHO score, quick Sequential Organ Failure Assessment (qSOFA), and DS-CRB 65 can be used to triage patients in the Emergency Department. They can be used to predict patients with the highest risk of seven-day mortality and need for intensive respiratory or vasopressor support (IRVS). The primary purpose was to find the score with the highest AUC in predicting IRVS and mortality at seven days. Additional objective was to find out any independent factors associated with IRVS and mortality. The data of adult patients who presented to the Emergency Department (ED) between April 1, 2021 and June 30, 2021 were collected. The WHO score, CRB-65, DS-CRB 65, PMEWS, NEWS2, and qSOFA score were calculated for all patients. Statistical analysis was done and an ROC curve was calculated for all the tools for mortality and need for IRVS at seven days. 677 patients presented to the Emergency Department with COVID-19 during the period above. Presence of Diabetes Mellitus (p = 0.001), Hypertension (p = 0.001), and chronic kidney disease(CKD) (p = 0.04) was significantly associated with need for IRVS. Age, duration of symptoms, pulse rate, respiratory rate, room air saturation, mental status at admission, and time to IRVS need were identified as independent predictors of in-hospital mortality. The longer the time to IRVS need from ED arrival, the higher the likelihood of mortality. PMEWS (0.830) had the highest AUC, followed by NEWS2 (0.805). A PMEWS cut-off of 6.5 was 74.2% sensitive and 78.3% specific in predicting the need for IRVS. ROC analysis to predict 7-day mortality showed that PMEWS had an AUC of 0.802 (0.766–0.839). QSOFA performed poorly in predicting IRVS (AUC 0.645) and 7-day mortality (AUC 0.677). PMEWS may be used for triaging patients presenting to the Emergency Department with COVID-19 and accurately predicts the need for IRVS and seven day mortality. •PMEWS has good sensitivity and specificity for predicting the need for intensive respiratory and vasopressor as well as mortality in the next seven days for COVID-19.•Other tools which can be used and that offer comparable ratios include NEWS2, DS-CRB 65, and WHO score.•The mortality incr
ISSN:0735-6757
1532-8171
1532-8171
DOI:10.1016/j.ajem.2024.01.034