Phoenix Medical Journal
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Acil Serviste Ciddi COVID-19 Vakalarında Kullanılan Risk Puanlama Sistemlerinin Performansı

Year 2022, Volume: 4 Issue: 3, 123 - 128, 10.11.2022

Birsen ERTEKİN Mehmet YORTANLI Ozan ÖZELBAYKAL Ali DOĞRU Abdullah Sadık GİRİŞGİN Tarık ACAR

https://doi.org/10.38175/phnx.1161754

Abstract

Amaç: Acil serviste COVID-19 hastalarında mortaliteyi öngörmede CURB-65, Quick Sequential Organ Failure Assessment (qSOFA) ve Ulusal Erken Uyarı Skoru 2 (NEWS 2) puanlarının performansını değerlendirmektir.
Yöntem: Bir pandemi hastanesinin acil servisinde ciddi COVID-19 tanısı alan toplam 502 hasta geriye dönük olarak incelendi. Hastaların demografik, klinik ve laboratuvar verilerine hastane kayıt sisteminden ulaşıldı. Her hastanın CURB-65, qSOFA ve NEWS2 skorları ayrı ayrı hesaplandı. Bütün hastalar hayatta kalanlar ve ölenler olarak iki gruba ayrıldı. Tüm parametreler ve hesaplanan risk skorları bu iki grup arasında istatistiksel olarak karşılaştırıldı.
Bulgular: 502 hastanın 281'i hayatta kalırken, 221'i öldü. CURB-65, NEWS2, qSOFA skorları iki hasta grubu arasında karşılaştırıldığında, anlamlı fark bulundu (p<0,001). CURB-65 ve qSOFA ile karşılaştırıldığında, NEWS2 ≥8 iken, %92,3 hassasiyet ve %90.2 NPV değerlerine sahipti. NEWS2 skoru, 0.86 AUC değeri ile diğer skorlar arasında en yüksek mortalite tahmin gücüne ulaştı.
Sonuç: NEWS2 skoru mortaliteyi tahmin etmede CURB-65 ve qSOFA'dan daha üstün bulunduğundan, ciddi COVID-19 hastalarının triyajında, prognozu tahmin etmede ve sonuçları iyileştirmede kullanılabilir.

Keywords

Covid-19;, Curb-65;, News2;, qsofa;, acil servis

References

  • Donnelly CA, Fisher MC, Fraser C, Ghani AC, Riley S, Ferguson NM et al. Epidemiological and genetic analysis of severe acute respiratory syndrome. Lancet Infect. Dis. 2004;4(11):672-83. doi. org/10.1016/S1473-3099(04)01173-9.
  • Shi Y, Pandita A, Hardesty A, McCarthy M, Aridi J, Weiss Z.F et all. Validation of pneumonia prognostic scores in a statewide cohort of hospitalised patients with COVID-19. Int J Clin Pract. 2020;e13926. doi: 10.1111/ijcp.13926.
  • Smith GB, Prytherch DR, Meredith P, Schmidt PE, Featherstone PI. The ability of the National early warning score (news) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death. Resuscitation. 2013;84:465–70. doi: 10.1016/j.resuscitation.2012.12.016.
  • Guo J , Zhou B, Zhu M, Yuan Y , Wang Q, Zhou H et al. CURB-65 may serve as a useful prognostic marker in COVID-19 patients within Wuhan, China: a retrospective cohort study. Epidemiol Infect. 2020;148:e241. doi: 10.1017/S0950268820002368.
  • McGinley A, Pearse R. A national early warning score for acutely ill patients. BMJ. 2012;345:e5310. doi: 10.1136/bmj.e5310.
  • Maitra S, Som A, Bhattacharjee S. Accuracy of quick sequential organ failure assessment (qSOFA) score and systemic inflammatory response syndrome (SIRS) criteria for predicting mortality in hospitalized patients with suspected infection: a metaanalysis of observational studies. Clin Microbiol Infect. 2018;24(11):1123–9. doi: 10.1016/j.cmi.2018.03.032.
  • Liu S, Yao N, Qiu Y, He C. Predictive performance of SOFA and qSOFA for in-hospital mortality in severe novel coronavirus disease. Am J Emerg Med. 2020;38(10):2074-2080. doi: 10.1016/.ajem.2020.07.019.
  • Ministry of Health, Republic of Turkey. Guidance to COVID-19(SARSCov2 infection). https://hsgm.saglik.gov.tr/depo/birimler/gocsagligi/covid19/rehber/COVID-19Rehberi20200414 eng v4 002 14.05.2020.pdf
  • Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A et al. Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315:762-74. doi: 10.1001/jama.2016.0288.
  • Lee YS, Choi JW, Park YH, Chung C, Park DI, Lee JE et al. Evaluation of the efficacy of the National Early Warning Score in predicting in-hospital mortality via the risk stratification. J Crit Care. 2018;47:222-6. doi: 10.1016/j.jcrc.2018.07.011.
  • Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72314 cases from the Chinese center for disease control and prevention. JAMA. 2020;323(13):1239-1242. doi: 10.1001/jama.2020.2648.
  • Cheng P, Wu H, Yang J, Song X, Xu M, Li B et al. Pneumonia scoring systems for severe COVID-19: which one is better. Virol J. 2021;18(1):33. doi: 10.1186/s12985-021-01502-6.
  • Swiss Academy Of Medical Sciences. COVID-19 pandemic: triage for intensive-care treatment under resource scarcity. Swiss Med Wkly. 2020;150:w20229. doi: 10.4414/smw.2020.20229.
  • Wynants L, Van Calster B, Bonten MMJ, Collins GS, Debray TPA, De Vos M et al. Prediction models for diagnosis and prognosis of covid-19 infection: Systematic review and critical appraisal. BMJ. 2020;7;369:m1328. doi: 10.1136/bmj.m1328.
  • Xie J, Tong Z, Guan X, Du B, Qiu H, Slutsky AS. Critical care crisis and some recommendations during the COVID-19 epidemic in China. Intensive Care Med. 2020;46(5):837-40. doi: 10.1007/s00134-020-05979-7.
  • Wunderink RG, Waterer G. Advances in the causes and management of community acquired pneumonia in adults. BMJ. 2017;358:j2471. doi: 10.1136/bmj.j2471.
  • Satici C, Demirkol MA, Sargin Altunok E, Gursoy B, Alkan M, Kamat S et al. Performance of pneumonia severity index and CURB-65 in predicting 30-day mortality in patients with COVID-19. Int J Infect Dis. 2020;98:84-89. doi: 10.1016/j.ijid.2020.06.038.
  • Bradley P, Frost F, Tharmaratnam K, Wootton D.G , NW Collaborative Organisation for Respiratory Research. Utility of established prognostic scores in COVID-19 hospital admissions: multicentre prospective evaluation of CURB-65, NEWS2 and qSOFA. BMJ Open Respir Res. 2020;7(1):e000729. doi: 10.1136/bmjresp-2020-000729.
  • Saberian P, Tavakoli N, Hasani-Sharamin P, Modabber M, Jamshididana M, Baratloo A. Accuracy of the pre-hospital triage tools (qSOFA, NEWS, and PRESEP) in predicting probable COVID-19 patients’ outcomes transferred by Emergency Medical Services. Caspian J Intern Med. 2020;11:536-543. doi: 10.22088/cjim.11.0.536.
  • Ferreira M, Blin T, Collercandy N, Szychowiak P, Dequin P.F, Jouan Y et al. Critically ill SARS-CoV-2-infected patients are not stratified as sepsis by the qSOFA. Ann Intensive Care 2020;10:43. doi: 10.1186/s13613-020-00664-w.
  • Jang JG, Hur J, Hong KS, Lee W, Ahn JH. Prognostic Accuracy of the SIRS, qSOFA, and NEWS for Early Detection of Clinical Deterioration in SARS-CoV-2 Infected Patients. J Korean Med Sci. 2020;35(25):e234. doi: 10.3346/jkms.2020.35.e234.
  • Alam N, Vegting IL, Houben E, Bekel B, Vaughan L , Kramer M.H.H et al. Exploring the performance of the National Early Warning Score (NEWS) in a European emergency department. Resuscitation. 2015;90:111–5. doi: 10.1016/j.resuscitation.2015.02.011.
  • Keep JW, Messmer AS, Sladden R, Burrell N, Pinate R, Tunnicliff M et al. National early warning score at Emergency Department triage may allow earlier identification of patients with severe sepsis and septic shock: a retrospective observational study. Emerg Med J. 2016;33:37-41. doi: 10.1136/emermed-2014-204465.
  • Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020;323:2052-9. doi: 10.1001/jama.2020.6775.
  • Sun Q, Qiu H, Huang M, Yang Y. Lower mortality of COVID-19 by early recognition and intervention: experience from Jiangsu province. Ann Intensive Care. 2020;10(1):33. doi: 10.1186/s13613-020-00650-2.
  • Myrstad M, Ihle-Hansen H, Tveita AA, Andersen EL, Nygård S, Tveit A et al. National Early Warning Score 2 (NEWS2) on admission predicts severe disease and in-hospital mortality from Covid-19-A prospective cohort study. Scand J Trauma Resusc Emerg Med. 2020;28:66. doi: 10.1186/s13049-020-00764-3.
  • Covino M, Sandroni C, Santoro M, Sabia L, Simeoni B, Bocci MG et al. Predicting intensive care unit admission and death for COVID-19 patients in the emergency department using early warning scores. Resuscitation. 2020;156:84-91. doi: 10.1016/j.resuscitation.2020.08.124.

The Performance of Risk Scoring Systems Used for Severe COVID-19 Cases in The Emergency Department

Year 2022, Volume: 4 Issue: 3, 123 - 128, 10.11.2022

Birsen ERTEKİN Mehmet YORTANLI Ozan ÖZELBAYKAL Ali DOĞRU Abdullah Sadık GİRİŞGİN Tarık ACAR

https://doi.org/10.38175/phnx.1161754

Abstract

Objective: The aim of this study is to evaluate the performance of CURB-65, Quick Sequential Organ Failure Assessment (qSOFA), and National Early Warning Score 2 (NEWS 2) scores in predicting mortality in COVID-19 patients in emergency department.
Method: A total of 502 patients diagnosed with severe COVID-19 in the emergency department of a pandemic hospital were analyzed retrospectively. Demographic, clinical and laboratory data of the patients were obtained from the hospital registry system. The CURB-65, qSOFA, and NEWS2 scores of each patient were calculated separately. These patients were divided into two groups as those who survived and those who died. All parameters and calculated risk scores were statistically compared between these two groups.
Results: While 281 out of 502 patients survived, 221 died. When the CURB-65, NEWS2, qSOFA scores were compared between the two patient groups, a significant difference was found (p<0.001 for all ). Compared with CURB-65 and qSOFA, sensitivity of 92.3% and NPV of 90.2% were detected when NEWS2≥8. The NEWS2 score reached the highest mortality predictive power among other scores with an AUC value of 0.86.
Conclusion: Because the NEWS2 score is superior to CURB-65 and qSOFA for predicting mortality, it can be used in the triage of severe COVID-19 patients, predicting prognosis and improving outcomes.

Keywords

Covıd-19;, Curb-65;, News2;, qsofa;, emergency service

References

  • Donnelly CA, Fisher MC, Fraser C, Ghani AC, Riley S, Ferguson NM et al. Epidemiological and genetic analysis of severe acute respiratory syndrome. Lancet Infect. Dis. 2004;4(11):672-83. doi. org/10.1016/S1473-3099(04)01173-9.
  • Shi Y, Pandita A, Hardesty A, McCarthy M, Aridi J, Weiss Z.F et all. Validation of pneumonia prognostic scores in a statewide cohort of hospitalised patients with COVID-19. Int J Clin Pract. 2020;e13926. doi: 10.1111/ijcp.13926.
  • Smith GB, Prytherch DR, Meredith P, Schmidt PE, Featherstone PI. The ability of the National early warning score (news) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death. Resuscitation. 2013;84:465–70. doi: 10.1016/j.resuscitation.2012.12.016.
  • Guo J , Zhou B, Zhu M, Yuan Y , Wang Q, Zhou H et al. CURB-65 may serve as a useful prognostic marker in COVID-19 patients within Wuhan, China: a retrospective cohort study. Epidemiol Infect. 2020;148:e241. doi: 10.1017/S0950268820002368.
  • McGinley A, Pearse R. A national early warning score for acutely ill patients. BMJ. 2012;345:e5310. doi: 10.1136/bmj.e5310.
  • Maitra S, Som A, Bhattacharjee S. Accuracy of quick sequential organ failure assessment (qSOFA) score and systemic inflammatory response syndrome (SIRS) criteria for predicting mortality in hospitalized patients with suspected infection: a metaanalysis of observational studies. Clin Microbiol Infect. 2018;24(11):1123–9. doi: 10.1016/j.cmi.2018.03.032.
  • Liu S, Yao N, Qiu Y, He C. Predictive performance of SOFA and qSOFA for in-hospital mortality in severe novel coronavirus disease. Am J Emerg Med. 2020;38(10):2074-2080. doi: 10.1016/.ajem.2020.07.019.
  • Ministry of Health, Republic of Turkey. Guidance to COVID-19(SARSCov2 infection). https://hsgm.saglik.gov.tr/depo/birimler/gocsagligi/covid19/rehber/COVID-19Rehberi20200414 eng v4 002 14.05.2020.pdf
  • Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A et al. Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315:762-74. doi: 10.1001/jama.2016.0288.
  • Lee YS, Choi JW, Park YH, Chung C, Park DI, Lee JE et al. Evaluation of the efficacy of the National Early Warning Score in predicting in-hospital mortality via the risk stratification. J Crit Care. 2018;47:222-6. doi: 10.1016/j.jcrc.2018.07.011.
  • Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72314 cases from the Chinese center for disease control and prevention. JAMA. 2020;323(13):1239-1242. doi: 10.1001/jama.2020.2648.
  • Cheng P, Wu H, Yang J, Song X, Xu M, Li B et al. Pneumonia scoring systems for severe COVID-19: which one is better. Virol J. 2021;18(1):33. doi: 10.1186/s12985-021-01502-6.
  • Swiss Academy Of Medical Sciences. COVID-19 pandemic: triage for intensive-care treatment under resource scarcity. Swiss Med Wkly. 2020;150:w20229. doi: 10.4414/smw.2020.20229.
  • Wynants L, Van Calster B, Bonten MMJ, Collins GS, Debray TPA, De Vos M et al. Prediction models for diagnosis and prognosis of covid-19 infection: Systematic review and critical appraisal. BMJ. 2020;7;369:m1328. doi: 10.1136/bmj.m1328.
  • Xie J, Tong Z, Guan X, Du B, Qiu H, Slutsky AS. Critical care crisis and some recommendations during the COVID-19 epidemic in China. Intensive Care Med. 2020;46(5):837-40. doi: 10.1007/s00134-020-05979-7.
  • Wunderink RG, Waterer G. Advances in the causes and management of community acquired pneumonia in adults. BMJ. 2017;358:j2471. doi: 10.1136/bmj.j2471.
  • Satici C, Demirkol MA, Sargin Altunok E, Gursoy B, Alkan M, Kamat S et al. Performance of pneumonia severity index and CURB-65 in predicting 30-day mortality in patients with COVID-19. Int J Infect Dis. 2020;98:84-89. doi: 10.1016/j.ijid.2020.06.038.
  • Bradley P, Frost F, Tharmaratnam K, Wootton D.G , NW Collaborative Organisation for Respiratory Research. Utility of established prognostic scores in COVID-19 hospital admissions: multicentre prospective evaluation of CURB-65, NEWS2 and qSOFA. BMJ Open Respir Res. 2020;7(1):e000729. doi: 10.1136/bmjresp-2020-000729.
  • Saberian P, Tavakoli N, Hasani-Sharamin P, Modabber M, Jamshididana M, Baratloo A. Accuracy of the pre-hospital triage tools (qSOFA, NEWS, and PRESEP) in predicting probable COVID-19 patients’ outcomes transferred by Emergency Medical Services. Caspian J Intern Med. 2020;11:536-543. doi: 10.22088/cjim.11.0.536.
  • Ferreira M, Blin T, Collercandy N, Szychowiak P, Dequin P.F, Jouan Y et al. Critically ill SARS-CoV-2-infected patients are not stratified as sepsis by the qSOFA. Ann Intensive Care 2020;10:43. doi: 10.1186/s13613-020-00664-w.
  • Jang JG, Hur J, Hong KS, Lee W, Ahn JH. Prognostic Accuracy of the SIRS, qSOFA, and NEWS for Early Detection of Clinical Deterioration in SARS-CoV-2 Infected Patients. J Korean Med Sci. 2020;35(25):e234. doi: 10.3346/jkms.2020.35.e234.
  • Alam N, Vegting IL, Houben E, Bekel B, Vaughan L , Kramer M.H.H et al. Exploring the performance of the National Early Warning Score (NEWS) in a European emergency department. Resuscitation. 2015;90:111–5. doi: 10.1016/j.resuscitation.2015.02.011.
  • Keep JW, Messmer AS, Sladden R, Burrell N, Pinate R, Tunnicliff M et al. National early warning score at Emergency Department triage may allow earlier identification of patients with severe sepsis and septic shock: a retrospective observational study. Emerg Med J. 2016;33:37-41. doi: 10.1136/emermed-2014-204465.
  • Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020;323:2052-9. doi: 10.1001/jama.2020.6775.
  • Sun Q, Qiu H, Huang M, Yang Y. Lower mortality of COVID-19 by early recognition and intervention: experience from Jiangsu province. Ann Intensive Care. 2020;10(1):33. doi: 10.1186/s13613-020-00650-2.
  • Myrstad M, Ihle-Hansen H, Tveita AA, Andersen EL, Nygård S, Tveit A et al. National Early Warning Score 2 (NEWS2) on admission predicts severe disease and in-hospital mortality from Covid-19-A prospective cohort study. Scand J Trauma Resusc Emerg Med. 2020;28:66. doi: 10.1186/s13049-020-00764-3.
  • Covino M, Sandroni C, Santoro M, Sabia L, Simeoni B, Bocci MG et al. Predicting intensive care unit admission and death for COVID-19 patients in the emergency department using early warning scores. Resuscitation. 2020;156:84-91. doi: 10.1016/j.resuscitation.2020.08.124.

Details

Primary Language English
Subjects Emergency Medicine
Journal Section Research Articles
Authors

Birsen ERTEKİN
Department of Emergency, University of Health Sciences, Beyhekim Training and Research Hospital
0000-0002-0630-8634
Türkiye

Mehmet YORTANLI
Department of Emergency, Numune State Hospital
0000-0002-6744-2423
Türkiye

Ozan ÖZELBAYKAL
Department of Emergency, Numune State Hospital
0000-0002-1112-3183
Türkiye

Ali DOĞRU
Department of Emergency, Numune State Hospital
0000-0003-4110-7886
Türkiye

Abdullah Sadık GİRİŞGİN
Department of Emergency, Necmettin Erbakan University Meram Faculty of Medicine
0000-0003-2669-0532
Türkiye

Tarık ACAR
Department of Emergency, University of Health Sciences, Beyhekim Training and Research Hospital
0000-0002-1131-4027
Türkiye

Supporting Institution yok
Project Number yok
Thanks yok
Publication Date November 10, 2022
Submission Date August 13, 2022
Acceptance Date September 6, 2022
Published in Issue Year 2022Volume: 4 Issue: 3

Cite

AMA Ertekin B. , Yortanlı M. , Özelbaykal O. , Doğru A. , Girişgin A. S. , Acar T. The Performance of Risk Scoring Systems Used for Severe COVID-19 Cases in The Emergency Department. Phnx Med J. 2022; 4(3): 123-128.
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