Prognostic accuracy of triage tools for adults with suspected COVID-19 in a prehospital setting: an observational cohort study

Abstract

BackgroundTools 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.MethodsAn 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.ResultsOf 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).ConclusionUse 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.

Emergency Medical Services Prehospital Response to the COVID-19 Pandemic in the US: A Brief Literature Review

“… Structural/ Systemic 53 Marincowitz et. al 65 Prognostic accuracy of triage tools for adults with suspected COVID-19 in a prehospital setting: an observational cohort study Cohort Patient care reports GB ● 65% of patients were transported to hospital and EMS decision to transfer patients achieved a sensitivity of 0.84. ● NEWS2, PMEWS, PRIEST tool and WHO algorithm identified pts at risk of adverse outcomes with a high sensitivity.…”

“…The WHO algorithm, PRIEST, NEWS2, and PMEWS tools all had high sensitivity for detecting COVID-19 infection. 65 In Uppsala, Sweden, Mälberg et al report correlational findings of physiological respiratory parameters with patients suspected of having COVID-19. They found that the odds of COVID-19 diagnosis increased with respiratory rate, lower tidal volume, and negative inspiratory pressure.…”

“…They found that the odds of COVID-19 diagnosis increased with respiratory rate, lower tidal volume, and negative inspiratory pressure. 65 In Paris, France, Jouffroy et al report that pulse oximetry may be a reliable indicator for the need of mechanical ventilation in COVID-19 patients. 38 It is important to acknowledge, however, that clinically significant inaccuracy of pulse oximetry for detecting hypoxia in darker skin patients has been well established in the literature.…”

EMS prehospital response to the COVID-19 pandemic in the US: A brief literature review

“…al report correlational findings of physiological respiratory parameters with patients suspected of having COVID-19. They found that the odds of COVID-19 diagnosis increased with respiratory rate, lower tidal volume, and negative inspiratory pressure (65) . In Paris, France, Jouffroy et.…”

“…al studied the accuracy of prognostic triage tools used prehospitally in the Yorkshire and Humber region. The WHO algorithm, PRIEST, NEWS2, and PMEWS tools all had high sensitivity for detecting COVID-19 infection (65) . In Uppsala, Sweden, Mälberg et.…”