Use of Early Warning Scoring Systems to Predict the Prognosis of COVID-19 Patients in the Emergency Department

Abstract

Aim: Increased emergency department (ED) admissions and the need for intensive care unit (ICU) brought with the pandemic has led to the need to make fast and accurate decisions. Early warning scores (EWS) may be useful in ED in this regard. This study was performed to evaluate the effectiveness of EWS in predicting mortality and need for ICU of patients with COVID-19. Materials and methods: This retrospective observational study was performed with subjects presented to the ED and were later admitted to a general ward or to the ICU because of COVID-19. Subjects aged ≥18 years with positive RT-PCR were included in the study. Subjects experienced a cardiac or respiratory arrest or intubated at the time of presentation to the ED and pregnant women were excluded from the study. MEWS, NEWS, NEWS-2, REMS, and qSOFA scores were calculated using patients’ data on first presentation. We examined the association of these scoring systems with mortality and need for ICU. Results: While 60(10%) of the 600 patients participating in the study were admitted to the ICU, 222(37%) patients died. The scoring systems’ negative predictive values for predicting ICU admission were 0.95, 0.98, 0.97, 0.96, and 0.96 respectively and for predicting mortality were 0.61, 0.67, 0.67, 0.66, and 0.61 respectively. All scorings assessed were significant predictors of the need for ICU and mortality in patients with COVID-19. Conclusions: All evaluated scoring systems were successful; however, NEWS and NEWS-2 had the highest predictive value both for the need for ICU and mortality.

Keywords

• Early warning score
• Emergency medicine
• COVID-19
• prognosis
• mortality

Acil Serviste COVID-19 Hastalarının Prognozunu Tahmin Etmek İçin Erken Uyarı Puanlama Sistemlerinin Kullanımı

Abstract

Amaç: Pandemi ile birlikte artan acil servis (AS) başvuruları ve yoğun bakım (YBÜ) ihtiyacı, hızlı ve doğru karar verme ihtiyacını doğurmuştur. Erken uyarı skorları (EUS) bu konuda acil serviste faydalı olabilir. Bu çalışma, EUS'nin COVID-19 hastalarının mortalitesini ve YBÜ ihtiyacını öngörmedeki etkinliğini değerlendirmek için yapıldı. Gereç ve yöntem: Bu retrospektif gözlemsel çalışma, acil servise sunulan ve daha sonra COVID-19 nedeniyle genel servise veya yoğun bakım ünitesine kabul edilen deneklerle gerçekleştirildi. Pozitif RT-PCR'si olan ≥18 yaşındaki denekler çalışmaya dahil edildi. Acil servise başvuru anında kalp veya solunum durması yaşayan veya entübe olan denekler ve hamile kadınlar çalışmadan çıkarıldı. MEWS, NEWS, NEWS-2, REMS ve qSOFA skorları hastaların ilk başvurudaki verileri kullanılarak hesaplandı. Bu skorlama sistemlerinin mortalite ve YBÜ ihtiyacı ile ilişkisini inceledik. Bulgular: Çalışmaya katılan 600 hastanın 60'ı (10%) yoğun bakıma alınırken, 222 (37%) hasta öldü. Puanlama sistemlerinin YBÜ yatışını öngörmedeki negatif tahmin değerleri sırasıyla 0.95, 0.98, 0.97, 0.96 ve 0.96 ve mortaliteyi tahmin etmede sırasıyla 0.61, 0.67, 0.67, 0.66 ve 0.61 idi. Değerlendirilen tüm skorlar, COVID-19 hastalarında YBÜ ihtiyacı ve mortalitenin önemli belirleyicileriydi. Tartışma: Değerlendirilen tüm puanlama sistemleri başarılıydı; ancak NEWS ve NEWS-2 hem YBÜ ihtiyacı hem de mortalite açısından en yüksek prediktif değere sahipti.

Keywords

• Erken uyarı skoru
• Acil tıp
• COVID-19
• prognoz
• mortalite

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