School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom.
Intensive Care, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom.
PLoS One. 2021 Jan 22;16(1):e0245840. doi: 10.1371/journal.pone.0245840. eCollection 2021.
We aimed to derive and validate a triage tool, based on clinical assessment alone, for predicting adverse outcome in acutely ill adults with suspected COVID-19 infection.
We undertook a mixed prospective and retrospective observational cohort study in 70 emergency departments across the United Kingdom (UK). We collected presenting data from 22445 people attending with suspected COVID-19 between 26 March 2020 and 28 May 2020. The primary outcome was death or organ support (respiratory, cardiovascular, or renal) by record review at 30 days. We split the cohort into derivation and validation sets, developed a clinical score based on the coefficients from multivariable analysis using the derivation set, and the estimated discriminant performance using the validation set.
We analysed 11773 derivation and 9118 validation cases. Multivariable analysis identified that age, sex, respiratory rate, systolic blood pressure, oxygen saturation/inspired oxygen ratio, performance status, consciousness, history of renal impairment, and respiratory distress were retained in analyses restricted to the ten or fewer predictors. We used findings from multivariable analysis and clinical judgement to develop a score based on the NEWS2 score, age, sex, and performance status. This had a c-statistic of 0.80 (95% confidence interval 0.79-0.81) in the validation cohort and predicted adverse outcome with sensitivity 0.98 (0.97-0.98) and specificity 0.34 (0.34-0.35) for scores above four points.
A clinical score based on NEWS2, age, sex, and performance status predicts adverse outcome with good discrimination in adults with suspected COVID-19 and can be used to support decision-making in emergency care.
ISRCTN registry, ISRCTN28342533, http://www.isrctn.com/ISRCTN28342533.
我们旨在开发并验证一种仅基于临床评估的分诊工具，用于预测疑似 COVID-19 感染的急性病成年人的不良结局。
我们在英国（UK）的 70 个急诊部门进行了一项混合前瞻性和回顾性观察队列研究。我们收集了 2020 年 3 月 26 日至 2020 年 5 月 28 日期间因疑似 COVID-19 就诊的 22445 人的就诊数据。主要结局是通过 30 天的记录回顾评估死亡或器官支持（呼吸、心血管或肾脏）。我们将队列分为推导集和验证集，基于推导集的多变量分析系数开发临床评分，并使用验证集估计判别性能。
我们分析了 11773 个推导集和 9118 个验证集。多变量分析确定年龄、性别、呼吸频率、收缩压、氧饱和度/吸氧比、表现状态、意识、肾功能损害史和呼吸困难是限制在十个或更少预测因素分析中保留的因素。我们使用多变量分析和临床判断的结果，在 NEWS2 评分、年龄、性别和表现状态的基础上开发了一种评分。在验证队列中，该评分的 C 统计量为 0.80（95%置信区间 0.79-0.81），预测不良结局的敏感度为 0.98（0.97-0.98），特异性为 0.34（0.34-0.35），评分高于四分。
基于 NEWS2、年龄、性别和表现状态的临床评分可对疑似 COVID-19 的成年人进行良好的不良结局预测，可用于支持急诊决策。
ISRCTN 注册表，ISRCTN28342533，http://www.isrctn.com/ISRCTN28342533。
