Derivation and validation of a clinical severity score for acutely ill adults with suspected COVID-19: The PRIEST observational cohort study

  1. Steve Goodacre
  2. Ben Thomas
  3. Laura Sutton
  4. Matthew Bursnall
  5. Ellen Lee
  6. Mike Bradburn
  7. Amanda Loban
  8. Simon Waterhouse
  9. Richard Simmonds
  10. Katie Biggs
  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

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.

Methods

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.

Results

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.

Conclusion

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.

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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