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

Year 2024, Volume: 6 Issue: 3, 126 - 132, 31.12.2024

Yasin Ugur , Ertan Sönmez , Bahadir Taslidere , Bedia Gülen

https://doi.org/10.55994/ejcc.1608271

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

Supporting Institution

nope

Project Number

yok

References

• 1. Berliner D, Schneider N, Welte T, Bauersachs J: [The Differential Diagnosis of Dyspnea]. Deutsches Ärzteblatt International 2016; 113: 834–45.
• 2. WHO Director-General's opening remarks at the media briefing on COVID-19: 11 March 2020. Published March 11, 2020. Accessed March 30, 2020.
• 3. Liu K, Chen Y, Lin R, Han K. Clinical feature of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J Infection 2020. [Epub ahead of print].
• 4. Lake MA. What we know so far: COVID-19 current clinical knowledge and research. Clin Med (Lond) 2020; 20: 124–7.
• 5. Rothana HA, Byrareddyb SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun 2020;109:102433. doi: 10.1016/j.jaut.2020.102433. Epub 2020 Feb 26.
• 6. Bulut C, Kato Y. Epidemiology of COVID-19. Turk J Med Sci (2020) 50:563-570.
• 7. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. The New England Journal of Medicine 2020; NEJMoa2002032. doi: 10.1056/NEJMoa2002032.
• 8. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al., Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China, Lancet 395 (10223) (2020) 497–506, https://doi.org/10.1016/S0140- 6736(20)30183-5.
• 9. Jin YH, Cai L, Cheng ZS, Cheng H, Deng T, Fan YP, et al., A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version), Mil. Med. Res. 7 (2020) 4.
• 10. Caruso D, Zerunian M, Polici M. Chest CT features of COVID-19 in Rome, Italy. Radiology 2020: 201237. doi: 10.1148/radiol.2020201237 (Epub ahead of print).
• 11. Xi Xu , Chengcheng Yu ,Jing Qu, Lieguang Zhang, Songfeng Jiang, Deyang Huang, et al. Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2. European Journal of Nuclear Medicine and Molecular Imaging https://doi.org/10.1007/s00259-020- 04735-9. February 2020.
• 12. C.P. Subbe, M. Kruger, P. Rutherford, L. Gemmel. Validation of a modified Early Warning Score in medical admissions. An International Journal of Medicine, Volume 94, Issue 10, October 2001, Pages 521–526.
• 13. Toshiya Mitsunaga, Izumu Hasegawa , Masahiko Uzura , Kenji Okuno, Kei Otani, Yuhei Ohtaki, Akihiro Sekine, Satoshi Takeda. Comparison of the National Early Warning Score (NEWS) and the Modified Early Warning Score (MEWS) for predicting admission and in- hospital mortality in elderly patients in the pre-hospital setting and in the emergency department. PeerJ 2019, DOI 10.7717/peerj.6947
• 14. Marcello Covino, Claudio Sandroni, Michele Santoro, Luca Sabia, Benedetta Simeoni, Maria Grazia Bocci, et al. Predicting intensive care unit admission and death for COVID-19 patients in the emergency department using early warning scores. Resuscitation 156 (2020) 84-91.