TY - JOUR T1 - Prognostic accuracy of triage tools for adults with suspected COVID-19 in a prehospital setting: an observational cohort study JF - Emergency Medicine Journal JO - Emerg Med J SP - 317 LP - 324 DO - 10.1136/emermed-2021-211934 VL - 39 IS - 4 AU - Carl Marincowitz AU - Laura Sutton AU - Tony Stone AU - Richard Pilbery AU - Richard Campbell AU - Benjamin Thomas AU - Janette Turner AU - Peter A Bath AU - Fiona Bell AU - Katie Biggs AU - Madina Hasan AU - Frank Hopfgartner AU - Suvodeep Mazumdar AU - Jennifer Petrie AU - Steve Goodacre Y1 - 2022/04/01 UR - http://emj.bmj.com/content/39/4/317.abstract N2 - Background Tools proposed to triage patient acuity in COVID-19 infection have only been validated in hospital populations. We estimated the accuracy of five risk-stratification tools recommended to predict severe illness and compared accuracy to existing clinical decision making in a prehospital setting.Methods An observational cohort study using linked ambulance service data for patients attended by Emergency Medical Service (EMS) crews in the Yorkshire and Humber region of England between 26 March 2020 and 25 June 2020 was conducted to assess performance of the Pandemic Respiratory Infection Emergency System Triage (PRIEST) tool, National Early Warning Score (NEWS2), WHO algorithm, CRB-65 and Pandemic Medical Early Warning Score (PMEWS) in patients with suspected COVID-19 infection. The primary outcome was death or need for organ support.Results Of the 7549 patients in our cohort, 17.6% (95% CI 16.8% to 18.5%) experienced the primary outcome. The NEWS2 (National Early Warning Score, version 2), PMEWS, PRIEST tool and WHO algorithm identified patients at risk of adverse outcomes with a high sensitivity (>0.95) and specificity ranging from 0.3 (NEWS2) to 0.41 (PRIEST tool). The high sensitivity of NEWS2 and PMEWS was achieved by using lower thresholds than previously recommended. On index assessment, 65% of patients were transported to hospital and EMS decision to transfer patients achieved a sensitivity of 0.84 (95% CI 0.83 to 0.85) and specificity of 0.39 (95% CI 0.39 to 0.40).Conclusion Use of NEWS2, PMEWS, PRIEST tool and WHO algorithm could improve sensitivity of EMS triage of patients with suspected COVID-19 infection. Use of the PRIEST tool would improve sensitivity of triage without increasing the number of patients conveyed to hospital.Data may be obtained from a third party and are not publicly available. The data used for this study are subject to data sharing agreements with NHS Digital and YAS which prohibits further sharing of individual level data. The datasets used are obtainable from these organisations subject to necessary authorisations and approvals. ER -