Current best evidence for clinical care (more info)
Background: COVID-19 may lead to severe disease, requiring intensive care treatment and challenging the capacity of health care systems. The aim of this study was to compare the ability of commonly used scoring systems for sepsis and pneumonia to predict severe COVID-19 in the emergency department.
Methods: Prospective, observational, single centre study in a secondary/tertiary care hospital in Oslo, Norway. Patients were assessed upon hospital admission using the following scoring systems; quick Sequential Failure Assessment (qSOFA), Systemic Inflammatory Response Syndrome criteria (SIRS), National Early Warning Score 2 (NEWS2), CURB-65 and Pneumonia Severity index (PSI). The ratio of arterial oxygen tension to inspiratory oxygen fraction (P/F-ratio) was also calculated. The area under the receiver operating characteristics curve (AUROC) for each scoring system was calculated, along with sensitivity and specificity for the most commonly used cut-offs. Severe disease was defined as death or treatment in ICU within 14 days.
Results: 38 of 175 study participants developed severe disease, 13 (7%) died and 29 (17%) had a stay at an intensive care unit (ICU). NEWS2 displayed an AUROC of 0.80 (95% confidence interval 0.72-0.88), CURB-65 0.75 (0.65-0.84), PSI 0.75 (0.65-0.84), SIRS 0.70 (0.61-0.80) and qSOFA 0.70 (0.61-0.79). NEWS2 was significantly better than SIRS and qSOFA in predicating severe disease, and with a cut-off of5 points, had a sensitivity and specificity of 82% and 60%, respectively.
Conclusion: NEWS2 predicted severe COVID-19 disease more accurately than SIRS and qSOFA, but not significantly better than CURB65 and PSI. NEWS2 may be a useful screening tool in evaluating COVID-19 patients during hospital admission.
Trial registration: : ClinicalTrials.gov Identifier: NCT04345536. (https://clinicaltrials.gov/ct2/show/NCT04345536).
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Various clinical prediction tools have been used to try to anticipate and intervene on patients with impending instability/risk of mortality. This manuscript advocates for use of the NEWS2 score, which is straightforward and efficient to calculate, for specific use in ED patients with COVID-19. While this small sample size and single-site setting limit the generalizability, these results may warrant local replication in hospitals struggling to adequately triage COVID-19 patients.
Despite this being a single-center study with the limitations noted by the authors, the study does inform on an assessment tool (NEWS2) that may be helpful in triaging patients to a more appropriate level of acute care from the emergency department. I would point out that the authors define severe disease as death or ICU admission within 14 days of admission from the ED. The Centers for Disease Control defines severe disease as admission to the hospital in general.