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Summary
Evaluation of COVID-19–specific pneumonia severity risk scales for use in Emergency Departments
Héctor Alonso Valle1, Enrique Peraita Fernández1, Oscar Miró2, Mar Ortega2, Sonia Jiménez2, Leticia Fresco2, Mª Luisa López Grima3, M.ª Ángeles Juan Gómez3, Begoña Espinosa4, Manuel Salido Mota5, Julio Bolanos Guedes6, Enrique Martín Mojarro7, Josep Tost8, María Pilar López Díez9, Rosa Sorando Serra10, M.ª José Cano Cano10, José María Ferreras11, Belén Arribas Entrala11, Rocío Moyano García12, Fahd Bedar Chaib13, Lluis Llauger García14, Nieves López-Laguna15, Mihai Podaru15, Salvador Pereira Sanz15, Lourdes Hernández Castells15, Sara Lainez Martínez16, Juan González del Castillo16, en representación de la red SIESTA
Affiliation of the authors
1Servicio de Urgencias, Hospital Universitario Marqués de Valdecilla, Santander, Spain. 2Servicio de Urgencias, Hospital Clínic, Barcelona, Spain. 3Servicio de Urgencias, Hospital Dr. Peset, Valencia, Spain. 4Servicio de Urgencias, Hospital Alicante, Alicante, Spain. 5Servicio de Urgencias, Hospital Universitario de Málaga, Spain. 6Servicio de Urgencias, Hospital del Mar, Barcelona, Spain. 7Hospital Santa Tecla, Tarragona, Spain. 8Hospital Terrassa, Terrassa, Barcelona, Spain. 9Hospital de Burgos, Spain. 10Hospital Arnau Villanova, Valencia, Spain. 11Hospital clínico Universitario Zaragoza, Spain. 12Hospital Valle de los Pedroches, Pozoblanco, Córdoba. Spain.13Hospital de Soria, Spain. 14Hospital de Vic, Barcelona, Spain. 15Clínica Universitaria Navarra, Madrid, Spain. 16Hospital Clínco San Carlos, Madrid, Spain.
DOI
Quote
Alonso Valle H, Peraita Fernández E, Miró O, Ortega M, Jiménez S, Fresco L, López Grima ML, Juan Gómez MA, Espinosa B, Salido Mota M, Bolanos Guedes J, Martín Mojarro E, Tost J, López Díez MP, Sorando Serra R, Cano Cano MJ, Ferreras JM, Arribas Entrala B, Moyano García R, Bedar Chaib F, Llauger García L, López-Laguna N, Podaru M, Pereira Sanz S, Hernández Castells L, Lainez Martínez S, González Del Castillo J. Evaluation of COVID-19–specific pneumonia severity risk scales for use in Emergency Departments. Rev Esp Urg Emerg. 2022;1:33–8
Summary
OBJECTIVE. To evaluate 2 scales for COVID-19 pneumonia severity and compare them to scales used to assess severity in general and community-acquired pneumonia.
METHODS. Retrospective study of patients diagnosed with pneumonia in the emergency department and who tested positive for COVID-19 between March 1 and April 30, 2020. In addition to recording age and sex, we calculated scores with the 2 specific tools (PREDICOVID and CLINIC) as well as the National Early Warning Score (NEWS), the Quick Sequential Organ Failure Assessment (qSOFA), the Pneumonia Severity Index (PSI), and the CURB 65 score (for confusion, blood urea nitrogen level, respiratory rate, and systolic blood pressure). Outcomes recorded were hospitalization, admission to an intensive care unit (ICU), in-hospital mortality, and 30-day mortality. The area under the receiver operating characteristic curve (AUC) was calculated to assess each score’s ability to predict mortality.
RESULTS. We analyzed data for 3499 patients. The mean (SD) age of patients included was 67.9 (17) years; 2660 of the patients (76%) were hospitalized, and 839 (27%) were admitted to the ICU. There were 630 in-hospital deaths (18.4%). Patients with PREDICOVID scores in the first to third quintiles had significantly lower in-hospital mortality (10.8% vs 38.1% in higher quintiles, P < .001). Patients with CLINIC scores indicating low to intermediate risk also had significantly lower in-hospital mortality (12.8% vs 85.7%, P < .001). The AUC values and 95% CIs for the scales as predictors of mortality were as follows: PSI, 0.69 (0.41-0.96); PREDICOVID, 0.65 (0.30-0.99); CLINIC, 0.63 (0.25-1.00), CURB-65, 0.62 (0.26-0.96); NEWS, 0.58 (0.23-0.94); and qSOFA, 0.38 (0.36-0.73).
CONCLUSIONS. All 6 scales were able to predict mortality. The PSI had the greatest predictive capacity.
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