Department of Emergency Medicine, Fundación Valle del Lili Cali, Colombia; Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia.
Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia.
Am J Emerg Med. 2024 Sep;83:101-108. doi: 10.1016/j.ajem.2024.07.006. Epub 2024 Jul 9.
In the context of the COVID-19 pandemic, the early and accurate identification of patients at risk of deterioration was crucial in overcrowded and resource-limited emergency departments. This study conducts an external validation for the evaluation of the performance of the National Early Warning Score 2 (NEWS2), the S/F ratio, and the ROX index at ED admission in a large cohort of COVID-19 patients from Colombia, South America, assessing the net clinical benefit with decision curve analysis.
A prospective cohort study was conducted on 6907 adult patients with confirmed COVID-19 admitted to a tertiary care ED in Colombia. The study evaluated the diagnostic performance of NEWS2, S/F ratio, and ROX index scores at ED admission using the area under the receiver operating characteristic curve (AUROC) for discrimination, calibration, and decision curve analysis for the prediction of intensive care unit admission, invasive mechanical ventilation, and in-hospital mortality.
We included 6907 patients who presented to the ED with confirmed SARS-CoV-2 infection from March 2020 to November 2021. Mean age was 51 (35-65) years and 50.4% of patients were males. The rate of intensive care unit admission was 28%, and in-hospital death was 9.8%. All three scores have good discriminatory performance for the three outcomes based on the AUROC. S/F ratio showed miscalibration at low predicted probabilities and decision curve analysis indicated that the NEWS2 score provided a greater net benefit compared to other scores across at a 10% threshold to decide ED admission at a high-level of care facility.
The NEWS2, S/F ratio, and ROX index at ED admission have good discriminatory performances in COVID-19 patients for the prediction of adverse outcomes, but the NEWS2 score has a higher net benefit underscoring its clinical utility in optimizing patient management and resource allocation in emergency settings.
在 COVID-19 大流行背景下，早期准确识别病情恶化风险患者对于拥挤和资源有限的急诊科至关重要。本研究在来自南美洲哥伦比亚的大量 COVID-19 患者队列中，对入院时的国家早期预警评分 2（NEWS2）、S/F 比值和 ROX 指数进行外部验证，通过决策曲线分析评估其净临床获益。
这是一项前瞻性队列研究，纳入了 6907 例在哥伦比亚一家三级护理急诊科确诊 COVID-19 的成年患者。该研究使用接受者操作特征曲线（AUROC）评估了 NEWS2、S/F 比值和 ROX 指数在入院时的诊断性能，用于区分、校准和决策曲线分析，以预测入住重症监护病房、有创机械通气和住院死亡率。
我们纳入了 6907 例 2020 年 3 月至 2021 年 11 月因 SARS-CoV-2 感染就诊急诊科的患者。患者平均年龄为 51（35-65）岁，50.4%为男性。入住重症监护病房的比例为 28%，住院死亡率为 9.8%。所有三个评分在 AUROC 上对三个结局都具有良好的区分性能。S/F 比值在低预测概率下显示出校准不良，决策曲线分析表明，与其他评分相比，NEWS2 评分在 10%阈值下提供了更大的净获益，用于决定在高医疗水平的医疗机构进行急诊科收治。
入院时的 NEWS2、S/F 比值和 ROX 指数在 COVID-19 患者中对不良结局的预测具有良好的区分性能，但 NEWS2 评分具有更高的净获益，突出了其在优化患者管理和急诊资源配置方面的临床实用性。
