The following is a summary of “Utility of ED triage tools in predicting the need for intensive respiratory or vasopressor support in adult patients with COVID-19,” published in the April 2024 issue of Emergency Medicine by Deva, et al.

Serum and radiological parameters commonly used to predict prognosis in patients with COVID-19 are often impractical in the Emergency Department (ED). Given the virus’s multi-organ impact, various scoring systems, including the Pandemic Medical Early Warning Score (PMEWS), National Early Warning Score 2 (NEWS2), WHO score, quick Sequential Organ Failure Assessment (qSOFA), and DS-CRB 65, have been proposed for triaging patients. These scores aim to identify individuals at the highest risk of requiring intensive respiratory or vasopressor support (IRVS) and experiencing seven-day mortality. For a study, researchers sought to determine which scoring system had the highest area under the curve (AUC) for predicting IRVS and mortality at seven days. Additionally, the study sought to identify any independent factors associated with IRVS and mortality.

Data were collected from adult patients presenting to the ED between April 1, 2021, and June 30, 2021. Scores, including the WHO score, CRB-65, DS-CRB 65, PMEWS, NEWS2, and qSOFA were calculated for each patient. Statistical analysis, including receiver operating characteristic (ROC) curve analysis, was conducted to assess the predictive performance of each scoring system.

Among the 677 patients with COVID-19 in the study, the presence of Diabetes Mellitus (P = 0.001), Hypertension (P = 0.001), and chronic kidney disease (CKD) (P = 0.04) was significantly associated with the need for IRVS. Several factors were identified as independent predictors of in-hospital mortality, including age, duration of symptoms, pulse rate, respiratory rate, room air saturation, mental status at admission, and time to IRVS. PMEWS demonstrated the highest AUC (0.830) for predicting IRVS, followed by NEWS2 (0.805). A PMEWS cutoff 6.5 yielded 74.2% sensitivity and 78.3% specificity for predicting IRVS. For predicting 7-day mortality, PMEWS also performed well with an AUC of 0.802. In contrast, qSOFA showed poorer performance in predicting IRVS (AUC 0.645) and 7-day mortality (AUC 0.677).

PMEWS was an effective tool for triaging patients with COVID-19 in the ED, accurately predicting the need for IRVS and seven-day mortality.

Reference: sciencedirect.com/science/article/abs/pii/S0735675724000354