Derivation and validation of a clinical severity score for acutely ill adults with suspected COVID-19: The PRIEST observational cohort study.
<h4>Objectives</h4>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.<h4>Methods</h4>We undertook a mixed prospective and retrospective observational cohort...
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Public Library of Science (PLoS)
2021-01-01
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| author | Steve Goodacre Ben Thomas Laura Sutton Matthew Burnsall Ellen Lee Mike Bradburn Amanda Loban Simon Waterhouse Richard Simmonds Katie Biggs Carl Marincowitz Jose Schutter Sarah Connelly Elena Sheldon Jamie Hall Emma Young Andrew Bentley Kirsty Challen Chris Fitzsimmons Tim Harris Fiona Lecky Andrew Lee Ian Maconochie Darren Walter |
| author_facet | Steve Goodacre Ben Thomas Laura Sutton Matthew Burnsall Ellen Lee Mike Bradburn Amanda Loban Simon Waterhouse Richard Simmonds Katie Biggs Carl Marincowitz Jose Schutter Sarah Connelly Elena Sheldon Jamie Hall Emma Young Andrew Bentley Kirsty Challen Chris Fitzsimmons Tim Harris Fiona Lecky Andrew Lee Ian Maconochie Darren Walter |
| author_sort | Steve Goodacre |
| collection | DOAJ |
| description | <h4>Objectives</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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, consciousness, 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 0.34 (0.34-0.35) for scores above four points.<h4>Conclusion</h4>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.<h4>Registration</h4>ISRCTN registry, ISRCTN28342533, http://www.isrctn.com/ISRCTN28342533. |
| format | Article |
| id | doaj-art-b406b6697052467f9b37eb7aa2b9215e |
| institution | OA Journals |
| issn | 1932-6203 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS ONE |
| spelling | doaj-art-b406b6697052467f9b37eb7aa2b9215e2025-08-20T02:22:21ZengPublic Library of Science (PLoS)PLoS ONE1932-62032021-01-01161e024584010.1371/journal.pone.0245840Derivation and validation of a clinical severity score for acutely ill adults with suspected COVID-19: The PRIEST observational cohort study.Steve GoodacreBen ThomasLaura SuttonMatthew BurnsallEllen LeeMike BradburnAmanda LobanSimon WaterhouseRichard SimmondsKatie BiggsCarl MarincowitzJose SchutterSarah ConnellyElena SheldonJamie HallEmma YoungAndrew BentleyKirsty ChallenChris FitzsimmonsTim HarrisFiona LeckyAndrew LeeIan MaconochieDarren Walter<h4>Objectives</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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, consciousness, 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 0.34 (0.34-0.35) for scores above four points.<h4>Conclusion</h4>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.<h4>Registration</h4>ISRCTN registry, ISRCTN28342533, http://www.isrctn.com/ISRCTN28342533.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0245840&type=printable |
| spellingShingle | Steve Goodacre Ben Thomas Laura Sutton Matthew Burnsall Ellen Lee Mike Bradburn Amanda Loban Simon Waterhouse Richard Simmonds Katie Biggs Carl Marincowitz Jose Schutter Sarah Connelly Elena Sheldon Jamie Hall Emma Young Andrew Bentley Kirsty Challen Chris Fitzsimmons Tim Harris Fiona Lecky Andrew Lee Ian Maconochie Darren Walter Derivation and validation of a clinical severity score for acutely ill adults with suspected COVID-19: The PRIEST observational cohort study. PLoS ONE |
| title | Derivation and validation of a clinical severity score for acutely ill adults with suspected COVID-19: The PRIEST observational cohort study. |
| title_full | Derivation and validation of a clinical severity score for acutely ill adults with suspected COVID-19: The PRIEST observational cohort study. |
| title_fullStr | Derivation and validation of a clinical severity score for acutely ill adults with suspected COVID-19: The PRIEST observational cohort study. |
| title_full_unstemmed | Derivation and validation of a clinical severity score for acutely ill adults with suspected COVID-19: The PRIEST observational cohort study. |
| title_short | Derivation and validation of a clinical severity score for acutely ill adults with suspected COVID-19: The PRIEST observational cohort study. |
| title_sort | derivation and validation of a clinical severity score for acutely ill adults with suspected covid 19 the priest observational cohort study |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0245840&type=printable |
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