COVID-19 Evidence Alerts
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Current best evidence for clinical care (more info)

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Clinical Prediction Guide Demir MC, Ilhan B Performance of the Pandemic Medical Early Warning Score (PMEWS), Simple Triage Scoring System (STSS) and Confusion, Uremia, Respiratory rate, Blood pressure and age >/= 65 (CURB-65) score among patients with COVID-19 pneumonia in an emergency department triage setting: a retrospective study. Sao Paulo Med J. 2021 Mar-Apr;139(2):170-177. doi: 10.1590/1516-3180.2020.0649.R1.10122020.

BACKGROUND: Healthcare institutions are confronted with large numbers of patient admissions during large-scale or long-term public health emergencies like pandemics. Appropriate and effective triage is needed for effective resource use.

OBJECTIVES: To evaluate the effectiveness of the Pandemic Medical Early Warning Score (PMEWS), Simple Triage Scoring System (STSS) and Confusion, Uremia, Respiratory rate, Blood pressure and age = 65 years (CURB-65) score in an emergency department (ED) triage setting.

DESIGN AND SETTING: Retrospective study in the ED of a tertiary-care university hospital in Düzce, Turkey.

METHODS: PMEWS, STSS and CURB-65 scores of patients diagnosed with COVID-19 pneumonia were calculated. Thirty-day mortality, intensive care unit (ICU) admission, mechanical ventilation (MV) need and outcomes were recorded. The predictive accuracy of the scores was assessed using receiver operating characteristic curve analysis.

RESULTS: One hundred patients with COVID-19 pneumonia were included. The 30-day mortality was 6%. PMEWS, STSS and CURB-65 showed high performance for predicting 30-day mortality (area under the curve: 0.968, 0.962 and 0.942, respectively). Age > 65 years, respiratory rate > 20/minute, oxygen saturation (SpO2) < 90% and ED length of stay > 4 hours showed associations with 30-day mortality (P < 0.05).

CONCLUSIONS: CURB-65, STSS and PMEWS scores are useful for predicting mortality, ICU admission and MV need among patients diagnosed with COVID-19 pneumonia. Advanced age, increased respiratory rate, low SpO2 and prolonged ED length of stay may increase mortality. Further studies are needed for developing the triage scoring systems, to ensure effective long-term use of healthcare service capacity during pandemics.

Discipline / Specialty Area Score
Emergency Medicine
Hospital Doctor/Hospitalists
Internal Medicine
Infectious Disease
Comments from MORE raters

Emergency Medicine rater

This is a retrospective study of about only 100 patients in a single center. This paper confirms what we already know.

Emergency Medicine rater

This article compares three scoring scales to predict outcomes, and triage patients diagnosed with Covid-19 infection. Although these are accurate, it's not yet clear that these would improve outcomes over current practice. They may be useful in a pandemic situation.

Infectious Disease rater

Excellent AUC for three prognostic scores in a small sample size study. The scores were not validated in a different sample.