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de Santos Castro PÁ, Martín-Rodríguez F, Arribas LTP, Sánchez DZ, Sanz-García A, Del Águila TGV, Izquierdo PG, de Santos Sánchez S, Del Pozo Vegas C. Head-to-head comparison of six warning scores to predict mortality and clinical impairment in COVID-19 patients in emergency department. Intern Emerg Med 2023; 18:2385-2395. [PMID: 37493862 DOI: 10.1007/s11739-023-03381-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 07/17/2023] [Indexed: 07/27/2023]
Abstract
The aim was to evaluate the ability of six risk scores (4C, CURB65, SEIMC, mCHOSEN, QuickCSI, and NEWS2) to predict the outcome of patients with COVID-19 during the sixth pandemic wave in Spain. A retrospective observational study was performed to review the electronic medical records in patients ≥ 18 years of age who consulted consecutively in an emergency department with COVID-19 diagnosis throughout 2 months during the sixth pandemic wave. Clinical-epidemiological variables, comorbidities, and their respective outcomes, such as 30-day in-hospital mortality and clinical deterioration risk (a combined outcome considering: mechanical ventilation, intensive care unit admission, and/or 30-day in-hospital mortality), were calculated. The area under the curve for each risk score was calculated, and the resulting curves were compared by the Delong test, concluding with a decision curve analysis. A total of 626 patients (median age 79 years; 49.8% female) fulfilled the inclusion criteria. Two hundred and ninety-three patients (46.8%) had two or more comorbidities. Clinical deterioration risk criteria were present in 10.1% (63 cases), with a 30-day in-hospital mortality rate of 6.2% (39 cases). Comparison of the results showed that score 4C presented the best results for both outcome variables, with areas under the curve for mortality and clinical deterioration risk of 0.931 (95% CI 0.904-0.957) and 0.871 (95% CI 0.833-0.910) (both p < 0.001). The 4C Mortality Score proved to be the best score for predicting mortality or clinical deterioration risk among patients with COVID-19 attended in the emergency department in the following 30 days.
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Affiliation(s)
- Pedro Ángel de Santos Castro
- Servicio de Urgencias, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla Y León (SACYL), Valladolid, Spain
| | - Francisco Martín-Rodríguez
- Facultad de Medicina, Centro de Simulación Clínica Avanzada, Universidad de Valladolid, Avda. Ramón Y Cajal, 7, 47003, Valladolid, Spain.
- Unidad Móvil de Emergencias Valladolid I, Gerencia de Emergencias Sanitarias, Gerencia Regional de Salud de Castilla Y León (SACYL), Valladolid, Spain.
| | - Leyre Teresa Pinilla Arribas
- Servicio de Urgencias, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla Y León (SACYL), Valladolid, Spain
| | - Daniel Zalama Sánchez
- Servicio de Urgencias, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla Y León (SACYL), Valladolid, Spain
| | - Ancor Sanz-García
- Facultad de Ciencias de La Salud, Universidad de Castilla La Mancha, Avda. Real Fábrica de Seda, s/n, 45600, Talavera de La Reina, Toledo, Spain.
| | - Tony Giancarlo Vásquez Del Águila
- Servicio de Urgencias, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla Y León (SACYL), Valladolid, Spain
| | - Pablo González Izquierdo
- Servicio de Urgencias, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla Y León (SACYL), Valladolid, Spain
| | - Sara de Santos Sánchez
- Facultad de Medicina, Centro de Simulación Clínica Avanzada, Universidad de Valladolid, Avda. Ramón Y Cajal, 7, 47003, Valladolid, Spain
| | - Carlos Del Pozo Vegas
- Servicio de Urgencias, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla Y León (SACYL), Valladolid, Spain
- Facultad de Medicina, Centro de Simulación Clínica Avanzada, Universidad de Valladolid, Avda. Ramón Y Cajal, 7, 47003, Valladolid, Spain
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