A COMPARISON OF OPERA AND MEWS SCORES IN PATIENTS APPLYING TO THE EMERGENCY DEPARTMENT WITH DYSPNEA DURING THE COVID-19 PANDEMIC PERIOD

Abstract

Introduction: During the COVID-19 pandemic, there were difficulties in diagnostic applications in patients who applied to the emergency department with dyspnea. We aimed to compare the Oxygen, Predisposing factors, Effusion, Radiology, Age (OPERA) scoring that we determined to be fast in diagnosis and treatment, with the Modified Early Warning Score (MEWS) scoring and imaging findings. We investigated the effectiveness of scoring in predicting prognosis and mortality. Method: Our retrospective cross-sectional study included 271 patients who presented to a university emergency department between 07 April and 31 July 2020 with dyspnea. MEWS and OPERA scores, demographic characteristics, vital signs, serological tests and detailed findings of computed tomography (CT) of the patients included in the study were scanned. Patients were analyzed in terms of diagnosis, need for intensive care, and two-month mortality. Results: A total of 271 patients (149 (55%) women, mean age 60.6 ± 18.1 years old) who presented to the emergency department with dyspnea were included in our study. While 43 (15.9%) patients died in the last two months, 69 (25.5%) patients needed intensive care. When the value of 4 was determined as the limit for the MEWS score, 21 (14.1%) patients admitted to the intensive care unit were found to be <4, while 48 (39.3%) patients were ≥4. While 9 (6.0%) of the patients with MEWS score <4 were mortal, 34 (27.9%) patients with MEWS score ≥4 were found to be mortal. OPERA score cutoff value of 6 was calculated. While 27 patients (12.8%) were admitted to the intensive care unit with a score of <6, 52 patients (37.7%) were hospitalized with a score of ≥6. While 4 (3.0%) patients with OPERA score <6 were mortal, 39 (28.3%) patients with ≥6 scores. While the sensitivity of the MEWS score was 69.6% and specificity 63.4% in the need for intensive care, the sensitivity was 79.1% and the specificity was 61.4% in mortality. In the OPERA scoring, the sensitivity for the need for intensive care was 75.4%, the specificity was 57.4%, while the sensitivity for mortality was 90.7% and the specificity was 56.6%. All results are similar between both scores and there is no statistically significant difference (p<0.001). Conclusion: While OPERA scoring is based on the patient's history and imaging, MEWS is calculated based on vital signs. However, no statistically significant difference was found in all results in terms of predicting both mortality and intensive care hospitalization in both scorings (p<0.00).

Keywords

• COVİD-19
• Dyspnea
• Mortality
• MEWS
• OPERA

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