Performance of the Pandemic Medical Early Warning Score (PMEWS), Simple Triage Scoring System (STSS) and Confusion, Uremia, Respiratory rate, Blood pressure and age ≥ 65 (CURB-65) score among patients with COVID-19 pneumonia in an emergency department triage setting: a retrospective study

Abstract

BACKGROUND: Healthcare institutions are confronted with large numbers of patient admissions during large-scale or long-term public health emergencies like pandemics. Appropriate and effective triage is needed for effective resource use. OBJECTIVES: To evaluate the effectiveness of the Pandemic Medical Early Warning Score (PMEWS), Simple Triage Scoring System (STSS) and Confusion, Uremia, Respiratory rate, Blood pressure and age ≥ 65 years (CURB-65) score in an emergency department (ED) triage setting. DESIGN AND SETTING: Retrospective study in the ED of a tertiary-care university hospital in Düzce, Turkey. METHODS: PMEWS, STSS and CURB-65 scores of patients diagnosed with COVID-19 pneumonia were calculated. Thirty-day mortality, intensive care unit (ICU) admission, mechanical ventilation (MV) need and outcomes were recorded. The predictive accuracy of the scores was assessed using receiver operating characteristic curve analysis. RESULTS: One hundred patients with COVID-19 pneumonia were included. The 30-day mortality was 6%. PMEWS, STSS and CURB-65 showed high performance for predicting 30-day mortality (area under the curve: 0.968, 0.962 and 0.942, respectively). Age > 65 years, respiratory rate > 20/minute, oxygen saturation (SpO 2) < 90% and ED length of stay > 4 hours showed associations with 30-day mortality (P < 0.05). CONCLUSIONS: CURB-65, STSS and PMEWS scores are useful for predicting mortality, ICU admission and MV need among patients diagnosed with COVID-19 pneumonia. Advanced age, increased respiratory rate, low SpO 2 and prolonged ED length of stay may increase mortality. Further studies are needed for developing the triage scoring systems, to ensure effective long-term use of healthcare service capacity during pandemics.

The feasibility of home self-assessment of vital signs and symptoms: A new key to telehealth for individuals?

“…The secondary objective of the study was to describe the link between abnormal vital signs and severe symptoms associated with COVID-19. Like other studies [13][14][15], oxygen saturation and RR appear to be the most altered vital signs in COVID-19. Systolic BP and HR appear to be poor predictors of deterioration of the clinical condition in COVID-19.…”

Comparison of prognostic scores for inpatients with COVID-19: a retrospective monocentric cohort study

“…Similarly, CURB-65 has been reported to perform well to predict 30-day mortality among patients with COVID-19,11 25 29–34 but results were less consistent regarding ICU admission 25 29–31 33…”

Performance of the CURB‐65, ISARIC‐4C and COVID‐GRAM scores in terms of severity for COVID‐19 patients

“…Demir et al used the Pandemic Medical Early Warning Score (PMEWS), Simple Triage Scoring System (STSS) and CURB‐65 score in ED triage for patients with COVID‐19 pneumonia; it was reported that these 3 scores were successful in determining mortality, ICU admission and the need for mechanical ventilation. 19 Recently, a study involving COVID‐19 patients in a hospital in Wuhan reported that CURB‐65 had good performance (AUC 0.81) in determining in‐hospital mortality. 20 In our study, the diagnostic performance of CURB‐65 (AUC 0.84) for mortality shows similarity with the study by Su et al (AUC 0.85), which was included 116 patients with COVID‐19 and whose primary outcome criteria were respiratory or vasopressor support.…”