Centre for Urgent and Emergency Care Research (CURE), School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
Information School, The University of Sheffield, Sheffield, UK.
Emerg Med J. 2023 Jul;40(7):509-517. doi: 10.1136/emermed-2022-212827. Epub 2023 May 22.
Tools proposed to triage ED acuity in suspected COVID-19 were derived and validated in higher income settings during early waves of the pandemic. We estimated the accuracy of seven risk-stratification tools recommended to predict severe illness in the Western Cape, South Africa.
An observational cohort study using routinely collected data from EDs across the Western Cape, from 27 August 2020 to 11 March 2022, was conducted to assess the performance of the PRIEST (Pandemic Respiratory Infection Emergency System Triage) tool, NEWS2 (National Early Warning Score, version 2), TEWS (Triage Early Warning Score), the WHO algorithm, CRB-65, Quick COVID-19 Severity Index and PMEWS (Pandemic Medical Early Warning Score) in suspected COVID-19. The primary outcome was intubation or non-invasive ventilation, death or intensive care unit admission at 30 days.
Of the 446 084 patients, 15 397 (3.45%, 95% CI 34% to 35.1%) experienced the primary outcome. Clinical decision-making for inpatient admission achieved a sensitivity of 0.77 (95% CI 0.76 to 0.78), specificity of 0.88 (95% CI 0.87 to 0.88) and the negative predictive value (NPV) of 0.99 (95% CI 0.99 to 0.99). NEWS2, PMEWS and PRIEST scores achieved good estimated discrimination (C-statistic 0.79 to 0.82) and identified patients at risk of adverse outcomes at recommended cut-offs with moderate sensitivity (>0.8) and specificity ranging from 0.41 to 0.64. Use of the tools at recommended thresholds would have more than doubled admissions, with only a 0.01% reduction in false negative triage.
No risk score outperformed existing clinical decision-making in determining the need for inpatient admission based on prediction of the primary outcome in this setting. Use of the PRIEST score at a threshold of one point higher than the previously recommended best approximated existing clinical accuracy.
用于分诊疑似 COVID-19 患者严重程度的工具是在大流行早期的高收入国家提出并验证的。我们评估了在南非西开普省推荐用于预测重症的七种风险分层工具的准确性。
这是一项观察性队列研究，使用 2020 年 8 月 27 日至 2022 年 3 月 11 日期间西开普省各地急诊科的常规收集数据进行，旨在评估 PRIEST（大流行呼吸道感染紧急系统分诊）工具、NEWS2（国家早期预警评分，第 2 版）、TEWS（分诊早期预警评分）、世界卫生组织算法、CRB-65、快速 COVID-19 严重程度指数和 PMEWS（大流行医疗早期预警评分）在疑似 COVID-19 中的表现。主要结局是 30 天内插管或无创通气、死亡或入住重症监护病房。
在 446084 名患者中，15397 名（3.45%，95%CI 34%至 35.1%）发生主要结局。住院决策的灵敏度为 0.77（95%CI 0.76 至 0.78），特异性为 0.88（95%CI 0.87 至 0.88），阴性预测值（NPV）为 0.99（95%CI 0.99 至 0.99）。NEWS2、PMEWS 和 PRIEST 评分具有良好的估计判别能力（C 统计量为 0.79 至 0.82），并在推荐切点处识别出有不良结局风险的患者，其敏感性>0.8，特异性范围为 0.41 至 0.64。在推荐阈值下使用这些工具会使入院人数增加一倍以上，而假阴性分诊的比例仅降低 0.01%。
在本研究中，没有一种风险评分在根据主要结局预测确定住院治疗需求方面优于现有的临床决策。使用 PRIEST 评分，其阈值比之前推荐的最佳阈值高 1 分，更接近现有临床准确性。
