Prognostic accuracy of emergency department triage tools for children with suspected COVID-19: The PRIEST observational cohort study

  1. The PRIEST Research Group
  2. Katie Biggs
  3. Ben Thomas
  4. Steve Goodacre
  5. Ellen Lee
  6. Laura Sutton
  7. Matthew Bursnall
  8. Amanda Loban
  9. Simon Waterhouse
  10. Richard Simmonds
  11. Carl Marincowitz
  12. Jose Schutter
  13. Sarah Connelly
  14. Elena Sheldon
  15. Jamie Hall
  16. Emma Young
  17. Andrew Bentley
  18. Kirsty Challen
  19. Chris Fitzimmons
  20. Tim Harris
  21. Fiona Lecky
  22. Andrew Lee
  23. Ian Maconochie
  24. Darren Walter
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Abstract

Objectives

Emergency department clinicians can use triage tools to predict adverse outcome and support management decisions for children presenting with suspected COVID-19. We aimed to estimate the accuracy of triage tools for predicting severe illness in children presenting to the emergency department (ED) with suspected COVID-19 infection.

Methods

We undertook a mixed prospective and retrospective observational cohort study in 44 EDs across the United Kingdom (UK). We collected data from children attending with suspected COVID-19 between 26 March 2020 and 28 May 2020, and used presenting data to determine the results of assessment using the WHO algorithm, swine flu hospital pathway for children (SFHPC), Paediatric Observation Priority Score (POPS) and Children’s Observation and Severity Tool (COAST). We recorded 30-day outcome data (death or receipt of respiratory, cardiovascular or renal support) to determine prognostic accuracy for adverse outcome.

Results

We collected data from 1530 children, including 26 (1.7%) with an adverse outcome. C-statistics were 0.80 (95% confidence interval 0.73-0.87) for the WHO algorithm, 0.80 (0.71-0.90) for POPS, 0.76 (0.67-0.85) for COAST, and 0.71 (0.59-0.82) for SFHPC. Using pre-specified thresholds, the WHO algorithm had the highest sensitivity (0.85) and lowest specificity (0.75), but POPS and COAST could optimise sensitivity (0.96 and 0.92 respectively) at the expense of specificity (0.25 and 0.38 respectively) by using a threshold of any score above zero instead of the pre-specified threshold.

Conclusion

Existing triage tools have good but not excellent prediction for adverse outcome in children with suspected COVID-19. POPS and COAST could achieve an appropriate balance of sensitivity and specificity for supporting decisions to discharge home by considering any score above zero to be positive.

Registration

ISRCTN registry, <ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="isrctn" xlink:href="28342533">ISRCTN28342533</ext-link>, <ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://www.isrctn.com/ISRCTN28342533">http://www.isrctn.com/ISRCTN28342533</ext-link>

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