TY - JOUR T1 - Prognostic accuracy of emergency department triage tools for adults with suspected COVID-19: the PRIEST observational cohort study JF - Emergency Medicine Journal JO - Emerg Med J DO - 10.1136/emermed-2020-210783 SP - emermed-2020-210783 AU - Ben Thomas AU - Steve Goodacre AU - Ellen Lee AU - Laura Sutton AU - Matthew Bursnall AU - Amanda Loban AU - Simon Waterhouse AU - Richard Simmonds AU - Katie Biggs AU - Carl Marincowitz AU - José Schutter AU - Sarah Connelly AU - Elena Sheldon AU - Jamie Hall AU - Emma Young AU - Andrew Bentley AU - Kirsty Challen AU - Chris Fitzsimmons AU - Tim Harris AU - Fiona Lecky AU - Andrew Lee AU - Ian Maconochie AU - Darren Walter Y1 - 2021/06/02 UR - http://emj.bmj.com/content/early/2021/06/03/emermed-2020-210783.abstract N2 - Background The WHO and National Institute for Health and Care Excellence recommend various triage tools to assist decision-making for patients with suspected COVID-19. We aimed to compare the accuracy of triage tools for predicting severe illness in adults presenting to the ED with suspected COVID-19.Methods We undertook a mixed prospective and retrospective observational cohort study in 70 EDs across the UK. We collected data from people attending with suspected COVID-19 and used presenting data to determine the results of assessment with the WHO algorithm, National Early Warning Score version 2 (NEWS2), CURB-65, CRB-65, Pandemic Modified Early Warning Score (PMEWS) and the swine flu adult hospital pathway (SFAHP). We used 30-day outcome data (death or receipt of respiratory, cardiovascular or renal support) to determine prognostic accuracy for adverse outcome.Results We analysed data from 20 891 adults, of whom 4611 (22.1%) died or received organ support (primary outcome), with 2058 (9.9%) receiving organ support and 2553 (12.2%) dying without organ support (secondary outcomes). C-statistics for the primary outcome were: CURB-65 0.75; CRB-65 0.70; PMEWS 0.77; NEWS2 (score) 0.77; NEWS2 (rule) 0.69; SFAHP (6-point rule) 0.70; SFAHP (7-point rule) 0.68; WHO algorithm 0.61. All triage tools showed worse prediction for receipt of organ support and better prediction for death without organ support. At the recommended threshold, PMEWS and the WHO criteria showed good sensitivity (0.97 and 0.95, respectively) at the expense of specificity (0.30 and 0.27, respectively). The NEWS2 score showed similar sensitivity (0.96) and specificity (0.28) when a lower threshold than recommended was used.Conclusion CURB-65, PMEWS and the NEWS2 score provide good but not excellent prediction for adverse outcome in suspected COVID-19, and predicted death without organ support better than receipt of organ support. PMEWS, the WHO criteria and NEWS2 (using a lower threshold than usually recommended) provide good sensitivity at the expense of specificity.Trial registration number ISRCTN56149622.Data are available in a public, open-access repository. Data are available upon reasonable request. Anonymised data are available from the corresponding author upon reasonable request (contact details on first page). ER -