PT  - JOURNAL ARTICLE
AU  - Veldhuis, Lars
AU  - Ridderikhof, Milan L
AU  - Schinkel, Michiel
AU  - van den Bergh, Joop
AU  - Beudel, Martijn
AU  - Dormans, Tom
AU  - Douma, Renee
AU  - Gritters van den Oever, Niels
AU  - de Haan, Lianne
AU  - Koopman, Karen
AU  - de Kruif, Martijn D
AU  - Noordzij, Peter
AU  - Reidinga, Auke
AU  - de Ruijter, Wouter
AU  - Simsek, Suat
AU  - Wyers, Caroline
AU  - Nanayakkara, Prabath WB
AU  - Hollmann, Markus
TI  - Early warning scores to assess the probability of critical illness in patients with COVID-19
AID  - 10.1136/emermed-2020-211054
DP  - 2021 Dec 01
TA  - Emergency Medicine Journal
PG  - 901--905
VI  - 38
IP  - 12
4099  - http://emj.bmj.com/content/38/12/901.short
4100  - http://emj.bmj.com/content/38/12/901.full
SO  - Emerg Med J2021 Dec 01; 38
AB  - Objective Validated clinical risk scores are needed to identify patients with COVID-19 at risk of severe disease and to guide triage decision-making during the COVID-19 pandemic. The objective of the current study was to evaluate the performance of early warning scores (EWS) in the ED when identifying patients with COVID-19 who will require intensive care unit (ICU) admission for high-flow-oxygen usage or mechanical ventilation.Methods Patients with a proven SARS-CoV-2 infection with complete resuscitate orders treated in nine hospitals between 27 February and 30 July 2020 needing hospital admission were included. Primary outcome was the performance of EWS in identifying patients needing ICU admission within 24 hours after ED presentation.Results In total, 1501 patients were included. Median age was 71 (range 19–99) years and 60.3% were male. Of all patients, 86.9% were admitted to the general ward and 13.1% to the ICU within 24 hours after ED admission. ICU patients had lower peripheral oxygen saturation (86.7% vs 93.7, p≤0.001) and had a higher body mass index (29.2 vs 27.9 p=0.043) compared with non-ICU patients. National Early Warning Score 2 (NEWS2) ≥ 6 and q-COVID Score were superior to all other studied clinical risk scores in predicting ICU admission with a fair area under the receiver operating characteristics curve of 0.740 (95% CI 0.696 to 0.783) and 0.760 (95% CI 0.712 to 0.800), respectively. NEWS2 ≥6 and q-COVID Score ≥3 discriminated patients admitted to the ICU with a sensitivity of 78.1% and 75.9%, and specificity of 56.3% and 61.8%, respectively.Conclusion In this multicentre study, the best performing models to predict ICU admittance were the NEWS2 and the Quick COVID-19 Severity Index Score, with fair diagnostic performance. However, due to the moderate performance, these models cannot be clinically used to adequately predict the need for ICU admission within 24 hours in patients with SARS-CoV-2 infection presenting at the ED.Data may be obtained from a third party and are not publicly available. We used data from the ongoing COVIDPredict Clinical Course Cohort. This is a nationwide database. Data may be used exclusively by scientists from the included hospitals.