Prognostic accuracy of triage tools for adults with suspected COVID-19 in a pre-hospital setting: an observational cohort study
Abstract Study Objective Tools 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 compare accuracy to existing clinical decision-making in a pre-hospital setting.Methods An observational cohort study using linked ambulance service data for patients attended by EMS crews in the Yorkshire and Humber region of England between 18th March 2020 and 29th June 2020 was conducted to assess performance of the PRIEST tool, NEWS2, the WHO algorithm, CRB-65 and PMEWS in patients with suspected COVID-19 infection. The primary outcome was death or need for organ support.Results Of 7549 patients in our cohort, 17.6% (95% CI:16.8% to 18.5%) experienced the primary outcome. The NEWS2, 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).Conclusion Use 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..
| Medienart: |
|
|---|
Preprint| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
bioRxiv.org - (2023) vom: 06. Nov. Zur Gesamtaufnahme - year:2023 |
|---|
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Marincowitz, Carl [VerfasserIn] |
|---|
| Links: |
Volltext [kostenfrei] |
|---|
| Themen: |
|---|
| doi: |
10.1101/2021.07.27.21261031 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
XBI032301472 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | XBI032301472 | ||
| 003 | DE-627 | ||
| 005 | 20231205150325.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 210801s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1101/2021.07.27.21261031 |2 doi | |
| 035 | |a (DE-627)XBI032301472 | ||
| 035 | |a (biorXiv)10.1101/2021.07.27.21261031 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Marincowitz, Carl |e verfasserin |0 (orcid)0000-0003-3043-7564 |4 aut | |
| 245 | 1 | 0 | |a Prognostic accuracy of triage tools for adults with suspected COVID-19 in a pre-hospital setting: an observational cohort study |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a Computermedien |b c |2 rdamedia | ||
| 338 | |a Online-Ressource |b cr |2 rdacarrier | ||
| 520 | |a Abstract Study Objective Tools 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 compare accuracy to existing clinical decision-making in a pre-hospital setting.Methods An observational cohort study using linked ambulance service data for patients attended by EMS crews in the Yorkshire and Humber region of England between 18th March 2020 and 29th June 2020 was conducted to assess performance of the PRIEST tool, NEWS2, the WHO algorithm, CRB-65 and PMEWS in patients with suspected COVID-19 infection. The primary outcome was death or need for organ support.Results Of 7549 patients in our cohort, 17.6% (95% CI:16.8% to 18.5%) experienced the primary outcome. The NEWS2, 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).Conclusion Use 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. | ||
| 650 | 4 | |a Biology |7 (dpeaa)DE-84 | |
| 650 | 4 | |a 570 |7 (dpeaa)DE-84 | |
| 700 | 1 | |a Sutton, Laura |0 (orcid)0000-0002-5043-2384 |4 aut | |
| 700 | 1 | |a Stone, Tony |0 (orcid)0000-0002-0167-3800 |4 aut | |
| 700 | 1 | |a Pilbery, Richard |0 (orcid)0000-0002-5797-9788 |4 aut | |
| 700 | 1 | |a Campbell, Richard |4 aut | |
| 700 | 1 | |a Thomas, Benjamin |0 (orcid)0000-0002-6659-6930 |4 aut | |
| 700 | 1 | |a Turner, Janette |0 (orcid)0000-0003-3884-7875 |4 aut | |
| 700 | 1 | |a Bath, Peter A. |0 (orcid)0000-0002-6310-7396 |4 aut | |
| 700 | 1 | |a Bell, Fiona |0 (orcid)0000-0003-4503-1903 |4 aut | |
| 700 | 1 | |a Biggs, Katie |0 (orcid)0000-0003-4468-7417 |4 aut | |
| 700 | 1 | |a Hasan, Madina |4 aut | |
| 700 | 1 | |a Hopfgartner, Frank |0 (orcid)0000-0003-0380-6088 |4 aut | |
| 700 | 1 | |a Mazumdar, Suvodeep |0 (orcid)0000-0002-0748-7638 |4 aut | |
| 700 | 1 | |a Petrie, Jennifer |4 aut | |
| 700 | 1 | |a Goodacre, Steve |0 (orcid)0000-0003-0803-8444 |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t bioRxiv.org |g (2023) vom: 06. Nov. |
| 773 | 1 | 8 | |g year:2023 |g day:06 |g month:11 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1101/2021.07.27.21261031 |z kostenfrei |3 Volltext |
| 912 | |a GBV_XBI | ||
| 951 | |a AR | ||
| 952 | |j 2023 |b 06 |c 11 | ||