Head-to-head comparison of six warning scores to predict mortality and clinical impairment in COVID-19 patients in emergency department

• Published in: Internal and emergency medicine 2023-11, Vol.18 (8), p.2385-2395
• Main Authors: de Santos Castro, Pedro Ángel, Martín-Rodríguez, Francisco, Arribas, Leyre Teresa Pinilla, Sánchez, Daniel Zalama, Sanz-García, Ancor, del Águila, Tony Giancarlo Vásquez, Izquierdo, Pablo González, de Santos Sánchez, Sara, del Pozo Vegas, Carlos
• Format: Article
• Language: English
• Subjects: Aged; Clinical Deterioration; Comorbidity; COVID-19; COVID-19 - epidemiology; COVID-19 : diagnosis; COVID-19 Testing; Electronic medical records; EM - Original; Emergency medical care; Emergency Service, Hospital; Epidemiology; Female; Hospital Mortality; Humans; Infant; Internal Medicine; Male; management and prognosis; Mechanical ventilation; Medicine; Medicine & Public Health; Mortality; Pandemics; Patients; Retrospective Studies; ROC Curve
• ISSN: 1828-0447; 1970-9366
• DOI: 10.1007/s11739-023-03381-x

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