Thirawattanasoot Netiporn, Chongthanadon Brandon, Ruangsomboon Onlak
Department of Emergency Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Int J Emerg Med. 2024 Dec 27;17(1):198. doi: 10.1186/s12245-024-00792-1.
Pneumonia is a potentially life-threatening respiratory tract infection. Many Early Warning Scores (EWS) were developed to detect patients with high risk for adverse clinical outcomes, but few have explored the utility of these EWS for pneumonia patients in the Emergency Department (ED) setting. We aimed to compare the prognostic utility of A-DROP, NEWS2, and REMS in predicting in-hospital mortality and the requirement for mechanical ventilation among ED patients with pneumonia.
A retrospective study was conducted at the ED of Siriraj Hospital, Thailand. Adult patients diagnosed with non-COVID-19 pneumonia between June 1, 2021, and May 31, 2022, were included. We calculated and analyzed their EWS at ED arrival. The primary outcome was all-cause in-hospital mortality. The secondary outcome was mechanical ventilation.
We enrolled 735 patients; 272 (37%) died at hospital discharge, and 75 (10.2%) required mechanical ventilation. A-DROP had the highest discrimination capacity for in-hospital mortality (AUROC: 0.698, 95% CI 0.659-0.737) compared to NEWS2 (AUROC 0.657; 95%CI 0.617, 0.698) and REMS (AUROC 0.637; 95%CI 0.596, 0.678). A-DROP also had superior performances than NEWS2 and REMS in terms of calibration, overall model performance, and balanced diagnostic accuracy indices at its optimal cut point (A-DROP ≥ 2). No EWS could perform well in predicting mechanical ventilation.
A-DROP had the highest prognostic utility for predicting in-hospital mortality in non-COVID-19 pneumonia patients in the ED compared to NEWS2 and REMS.
肺炎是一种可能危及生命的呼吸道感染。许多早期预警评分（EWS）被开发出来以检测具有不良临床结局高风险的患者，但很少有人探讨这些EWS在急诊科（ED）环境中对肺炎患者的实用性。我们旨在比较A-DROP、NEWS2和REMS在预测急诊科肺炎患者院内死亡率和机械通气需求方面的预后效用。
在泰国诗里拉吉医院急诊科进行了一项回顾性研究。纳入2021年6月1日至2022年5月31日期间诊断为非COVID-19肺炎的成年患者。我们在患者到达急诊科时计算并分析了他们的EWS。主要结局是全因院内死亡率。次要结局是机械通气。
我们纳入了735例患者；272例（37%）在出院时死亡，75例（10.2%）需要机械通气。与NEWS2（AUROC 0.657；95%CI 0.617，0.698）和REMS（AUROC 0.637；95%CI 0.596，0.678）相比，A-DROP对院内死亡率的鉴别能力最高（AUROC：0.698，95%CI 0.659 - 0.737）。在校准、总体模型性能以及其最佳切点（A-DROP≥2）处的平衡诊断准确性指数方面，A-DROP也比NEWS2和REMS表现更优。没有EWS在预测机械通气方面表现良好。
与NEWS2和REMS相比，A-DROP在预测急诊科非COVID-19肺炎患者院内死亡率方面具有最高的预后效用。
