Accuracy of early warning scores for predicting clinical worsening in COPD patients
Background COPD, a condition whose acute exacerbations (AECOPD) are commonly faced by the emergency medical services (EMSs), could modify the performance of early warning scores (EWSs). Our objectives were to assess the 2-day mortality predictive performance of five EWSs in patients with baseline CO...
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| Format: | Article |
| Language: | English |
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European Respiratory Society
2025-04-01
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| Series: | ERJ Open Research |
| Online Access: | http://openres.ersjournals.com/content/11/2/00744-2024.full |
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| author | Enrique Castro-Portillo Joan B. Soriano Raúl López-Izquierdo Carlos del Pozo Vegas José L. Martín-Conty Irene Sánchez Soberón Juan F. Delgado Benito Begoña Polonio-López Manuel Sánchez-de-la-Torre Miguel Á. Castro Villamor Ancor Sanz-García Francisco Martín-Rodríguez |
| author_facet | Enrique Castro-Portillo Joan B. Soriano Raúl López-Izquierdo Carlos del Pozo Vegas José L. Martín-Conty Irene Sánchez Soberón Juan F. Delgado Benito Begoña Polonio-López Manuel Sánchez-de-la-Torre Miguel Á. Castro Villamor Ancor Sanz-García Francisco Martín-Rodríguez |
| author_sort | Enrique Castro-Portillo |
| collection | DOAJ |
| description | Background
COPD, a condition whose acute exacerbations (AECOPD) are commonly faced by the emergency medical services (EMSs), could modify the performance of early warning scores (EWSs). Our objectives were to assess the 2-day mortality predictive performance of five EWSs in patients with baseline COPD managed by an EMS with unselected acute diseases and to compare the EWS performance between those with AECOPD and those without.
Methods
This was a prospective observational study of adults (age >18 years) with a previous COPD diagnosis who were admitted to and transferred to the emergency department by the EMSs due to an unselected acute disease, whether AECOPD or other according to the emergency medical team. Demographics, vital signs for the five EWSs (National Early Warning Score 2 (NEWS2), quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA), quick COVID-19 Severity Index (qCSI), CURB-65 score for pneumonia severity and BAP-65 score for AECOPD) calculations and outcomes (hospital and intensive care unit (ICU) admission and 2-day mortality) were collected.
Results
A total of 1703 patients with COPD were selected: 524 with AECOPD and 1179 without. NEWS2 presented the highest predictive capacity for the global, AECOPD and non-AECOPD cohorts: area under the curve 0.880 (95% CI 0.84–0.91), 0.775 (95% CI 0.68–0.86) and 0.913 (95% CI 0.86–0.96), respectively.
Conclusions
NEWS2 was the best predictive model for COPD, presenting excellent performance for the global and non-AECOPD cohorts but a decreased performance for the AECOPD cohort. Therefore, NEWS2 may aid in EMS decision making through appropriate risk assessment, but its use in COPD patients with AECOPD should be handled with care due to decreased performance. |
| format | Article |
| id | doaj-art-60e9f90b667342e4ae4468acf29a042c |
| institution | OA Journals |
| issn | 2312-0541 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | European Respiratory Society |
| record_format | Article |
| series | ERJ Open Research |
| spelling | doaj-art-60e9f90b667342e4ae4468acf29a042c2025-08-20T02:10:43ZengEuropean Respiratory SocietyERJ Open Research2312-05412025-04-0111210.1183/23120541.00744-202400744-2024Accuracy of early warning scores for predicting clinical worsening in COPD patientsEnrique Castro-Portillo0Joan B. Soriano1Raúl López-Izquierdo2Carlos del Pozo Vegas3José L. Martín-Conty4Irene Sánchez Soberón5Juan F. Delgado Benito6Begoña Polonio-López7Manuel Sánchez-de-la-Torre8Miguel Á. Castro Villamor9Ancor Sanz-García10Francisco Martín-Rodríguez11 Primary Health Care Unit, Centro de Salud Delicias I, Gerencia Regional de Salud de Castilla y León, Valladolid, Spain Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain Pre-hospital Critical Care, Emergency Medical Services, Gerencia Regional de Salud de Castilla y León, Valladolid, Spain Pre-hospital Critical Care, Emergency Medical Services, Gerencia Regional de Salud de Castilla y León, Valladolid, Spain Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain Background COPD, a condition whose acute exacerbations (AECOPD) are commonly faced by the emergency medical services (EMSs), could modify the performance of early warning scores (EWSs). Our objectives were to assess the 2-day mortality predictive performance of five EWSs in patients with baseline COPD managed by an EMS with unselected acute diseases and to compare the EWS performance between those with AECOPD and those without. Methods This was a prospective observational study of adults (age >18 years) with a previous COPD diagnosis who were admitted to and transferred to the emergency department by the EMSs due to an unselected acute disease, whether AECOPD or other according to the emergency medical team. Demographics, vital signs for the five EWSs (National Early Warning Score 2 (NEWS2), quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA), quick COVID-19 Severity Index (qCSI), CURB-65 score for pneumonia severity and BAP-65 score for AECOPD) calculations and outcomes (hospital and intensive care unit (ICU) admission and 2-day mortality) were collected. Results A total of 1703 patients with COPD were selected: 524 with AECOPD and 1179 without. NEWS2 presented the highest predictive capacity for the global, AECOPD and non-AECOPD cohorts: area under the curve 0.880 (95% CI 0.84–0.91), 0.775 (95% CI 0.68–0.86) and 0.913 (95% CI 0.86–0.96), respectively. Conclusions NEWS2 was the best predictive model for COPD, presenting excellent performance for the global and non-AECOPD cohorts but a decreased performance for the AECOPD cohort. Therefore, NEWS2 may aid in EMS decision making through appropriate risk assessment, but its use in COPD patients with AECOPD should be handled with care due to decreased performance.http://openres.ersjournals.com/content/11/2/00744-2024.full |
| spellingShingle | Enrique Castro-Portillo Joan B. Soriano Raúl López-Izquierdo Carlos del Pozo Vegas José L. Martín-Conty Irene Sánchez Soberón Juan F. Delgado Benito Begoña Polonio-López Manuel Sánchez-de-la-Torre Miguel Á. Castro Villamor Ancor Sanz-García Francisco Martín-Rodríguez Accuracy of early warning scores for predicting clinical worsening in COPD patients ERJ Open Research |
| title | Accuracy of early warning scores for predicting clinical worsening in COPD patients |
| title_full | Accuracy of early warning scores for predicting clinical worsening in COPD patients |
| title_fullStr | Accuracy of early warning scores for predicting clinical worsening in COPD patients |
| title_full_unstemmed | Accuracy of early warning scores for predicting clinical worsening in COPD patients |
| title_short | Accuracy of early warning scores for predicting clinical worsening in COPD patients |
| title_sort | accuracy of early warning scores for predicting clinical worsening in copd patients |
| url | http://openres.ersjournals.com/content/11/2/00744-2024.full |
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