Department of Emergency Medicine, University of Health Sciences Umraniye Training and Research Hospital, Istanbul, Turkey.
Department of Emergency Medicine, University of Health Sciences Umraniye Training and Research Hospital, Istanbul, Turkey.
Am J Emerg Med. 2021 Nov;49:259-264. doi: 10.1016/j.ajem.2021.06.020. Epub 2021 Jun 10.
We investigated the effectiveness of the Rapid Emergency Medicine Score and the Rapid Acute Physiology Score in identifying critical patients among those presenting to the emergency department with COVID-19 symptoms.
This prospective, observational, cohort study included patients with COVID-19 symptoms presenting to the emergency department over a two-month period. Demographics, clinical characteristics, and the data of all-cause mortality within 30 days after admission were noted, and the Rapid Emergency Medicine Score and the Rapid Acute Physiology Score were calculated by the researchers. The receiver operating characteristic curve analysis was performed to determine the discriminative ability of the scores.
A total of 555 patients with a mean of age of 49.4 ± 16.8 years were included in the study. The rate of 30-day mortality was 3.9% for the whole study cohort, 7.2% for the patients with a positive rt-PCR test result for SARS-CoV-2, and 1.2% for those with a negative rt-PCR test result for SARS-CoV-2. In the group of patients with COVID-19 symptoms, according to the best Youden's index, the cut-off value for the Rapid Emergency Medicine Score was determined as 3.5 (sensitivity: 81.82%, specificity: 73.08%), and the area under curve (AUC) value was 0.840 (95% confidence interval 0.768-0.913). In the same group, according to the best Youden's index, the cut-off value for the Rapid Acute Physiology Score was 2.5 (sensitivity: 90.9%, specificity: 97.38%), and the AUC value was 0.519 (95% confidence interval 0.393-0.646).
REMS is able to predict patients with COVID-19-like symptoms without positive rt-PCR for SARS-CoV-2 that are at a high-risk of 30-day mortality. Prospective multicenter cohort studies are needed to provide best scoring system for triage in pandemic clinics.
我们旨在研究快速急诊医学评分和快速急性生理学评分在识别因 COVID-19 症状就诊急诊科的危急患者中的有效性。
这是一项前瞻性、观察性队列研究，纳入了两个月期间因 COVID-19 症状就诊急诊科的患者。记录了患者的人口统计学、临床特征以及入院后 30 天内全因死亡率的数据，并由研究人员计算了快速急诊医学评分和快速急性生理学评分。通过受试者工作特征曲线分析来确定评分的鉴别能力。
共纳入 555 例患者，平均年龄为 49.4±16.8 岁。全研究队列的 30 天死亡率为 3.9%，SARS-CoV-2 逆转录聚合酶链反应（rt-PCR）检测结果阳性的患者为 7.2%，SARS-CoV-2 rt-PCR 检测结果阴性的患者为 1.2%。在有 COVID-19 症状的患者中，根据最佳约登指数，确定快速急诊医学评分的截断值为 3.5（灵敏度：81.82%，特异性：73.08%），曲线下面积（AUC）值为 0.840（95%置信区间 0.768-0.913）。在同一组患者中，根据最佳约登指数，快速急性生理学评分的截断值为 2.5（灵敏度：90.9%，特异性：97.38%），AUC 值为 0.519（95%置信区间 0.393-0.646）。
REMS 能够预测无 SARS-CoV-2 阳性 rt-PCR 的 COVID-19 样症状患者，其 30 天死亡率风险较高。需要前瞻性多中心队列研究为大流行诊所的分诊提供最佳评分系统。
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