Derivation and validation of a clinical severity score for acutely ill adults with suspected COVID-19: The PRIEST observational cohort study

Abstract

Objectives We aimed to derive and validate a triage tool, based on clinical assessment alone, for predicting adverse outcome in acutely ill adults with suspected COVID-19 infection. Methods We undertook a mixed prospective and retrospective observational cohort study in 70 emergency departments across the United Kingdom (UK). We collected presenting data from 22445 people attending with suspected COVID-19 between 26 March 2020 and 28 May 2020. The primary outcome was death or organ support (respiratory, cardiovascular, or renal) by record review at 30 days. We split the cohort into derivation and validation sets, developed a clinical score based on the coefficients from multivariable analysis using the derivation set, and the estimated discriminant performance using the validation set. Results We analysed 11773 derivation and 9118 validation cases. Multivariable analysis identified that age, sex, respiratory rate, systolic blood pressure, oxygen saturation/inspired oxygen ratio, performance status, history of renal impairment, and respiratory distress were retained in analyses restricted to the ten or fewer predictors. We used findings from multivariable analysis and clinical judgement to develop a score based on the NEWS2 score, age, sex, and performance status. This had a c-statistic of 0.80 (95% confidence interval 0.79-0.81) in the validation cohort and predicted adverse outcome with sensitivity 0.98 (0.97-0.98) and specificity 0.38 (0.38-0.39) for scores above four points. Conclusion A clinical score based on NEWS2, age, sex, and performance status predicts adverse outcome with good discrimination in adults with suspected COVID-19 and can be used to support decision-making in emergency care.

Do Not Attempt Resuscitation (DNAR) status in people with suspected COVID-19: Secondary analysis of the PRIEST observational cohort study

“…Figures 1 compares the NEWS2 scores for the two groups and shows that those with early DNAR decisions tended to be more acutely unwell (median score 6 versus 5). Figure 2 compares the PRIEST COVID-19 clinical severity scores for the two groups and shows that those with early DNAR decisions were at a higher risk of adverse outcome (median score 12 versus 9, respectively indicating 38% versus 26% expected risk of a 30-day adverse outcome) [17].…”

“…We calculated a National Early Warning Score (2nd version, NEWS2) for adults, [16] to provide an overall assessment of acute illness severity on a score from zero to 20, based on respiratory rate, oxygen saturation, systolic blood pressure, heart rate, level of consciousness and temperature. We calculated a PRIEST COVID-19 clinical severity score, to provide an overall prediction of the risk of adverse outcome on a score from zero to 29, based on NEWS2, age, sex and performance status [17].…”

Validating the RISE UP score for predicting prognosis in patients with COVID-19 in the emergency department, a retrospective study

“…[17] New prediction models will be developed for patients with COVID-19, such as two recently published studies, that show good results and should definitely be included in future studies. [18, 19] The RISE UP score is an accurate and externally validated prediction model with good discriminatory value in unselected older medical patients. [7] We state that the RISE UP score can be used in current clinical practice.…”

Do not attempt cardiopulmonary resuscitation (DNACPR) decisions in people admitted with suspected COVID-19: Secondary analysis of the PRIEST observational cohort study

“…We calculated a PRIEST COVID-19 clinical severity score, to provide an overall prediction of the risk of adverse outcome on a score from zero to 29, based on NEWS2, age, sex and performance status. 17 …”