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

2020 ◽  
Author(s):  
Katie Biggs ◽  
Ben Thomas ◽  
Steve Goodacre ◽  
Ellen Lee ◽  
Laura Sutton ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Adverse Outcome ◽  
Outcome Data ◽  
Observational Cohort Study ◽  
Swine Flu ◽  
Severe Illness ◽  
Prognostic Accuracy ◽  
Emergency Department Triage ◽  
Observational Cohort

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 Childrens 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.

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

2020 ◽  
Author(s):  
Ben Thomas ◽  
Steve Goodacre ◽  
Ellen Lee ◽  
Laura Sutton ◽  
Amanda Loban ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Primary Outcome ◽  
Adverse Outcome ◽  
Observational Cohort Study ◽  
Organ Support ◽  
Good Sensitivity ◽  
Who Criteria ◽  
Prognostic Accuracy ◽  
Observational Cohort

Objectives: The World Health Organisation (WHO) and National Institute for Health and Care Excellence (NICE) recommend various triage tools to assist decision-making for patients with suspected COVID-19. We aimed to estimate the accuracy of triage tools for predicting severe illness in adults presenting to the emergency department (ED) with suspected COVID-19 infection. Methods: We undertook a mixed prospective and retrospective observational cohort study in 70 EDs across the United Kingdom (UK). We collected data from people attending with suspected COVID-19 between 26 March 2020 and 28 May 2020, and used presenting data to determine the results of assessment with the following triage tools: the WHO algorithm, NEWS2, CURB-65, CRB-65, PMEWS and the swine flu adult hospital pathway (SFAHP). We used 30-day outcome data (death or receipt of respiratory, cardiovascular or renal support) to determine prognostic accuracy for adverse outcome. Results: We analysed data from 20892 adults, of whom 4672 (22.4%) died or received organ support (primary outcome), with 2058 (9.9%) receiving organ support and 2614 (12.5%) dying without organ support (secondary outcomes). C-statistics for the primary outcome were: CURB-65 0.75; CRB-65 0.70; PMEWS 0.77; NEWS2 (score) 0.77; NEWS2 (rule) 0.69; SFAHP (6-point) 0.70; SFAHP (7-point) 0.68; WHO algorithm 0.61. All triage tools showed worse prediction for receipt of organ support and better prediction for death without organ support. At the recommended threshold, PMEWS and the WHO criteria showed good sensitivity (0.96 and 0.95 respectively), at the expense of specificity (0.31 and 0.27 respectively). NEWS2 showed similar sensitivity (0.96) and specificity (0.28) when a lower threshold than recommended was used. Conclusion: CURB-65, PMEWS and NEWS2 provide good but not excellent prediction for adverse outcome in suspected COVID-19, and predicted death without organ support better than receipt of organ support. PMEWS, the WHO criteria and NEWS2 (using a lower threshold than usually recommended) provide good sensitivity at the expense of specificity.

scholarly journals Prognostic accuracy of emergency department triage tools for adults with suspected COVID-19: the PRIEST observational cohort study

2021 ◽  
pp. emermed-2020-210783
Author(s):  
Ben Thomas ◽  
Steve Goodacre ◽  
Ellen Lee ◽  
Laura Sutton ◽  
Matthew Bursnall ◽  
...  
Keyword(s):  
Cohort Study ◽  
Primary Outcome ◽  
Adverse Outcome ◽  
Observational Cohort Study ◽  
Early Warning Score ◽  
Organ Support ◽  
Good Sensitivity ◽  
Who Criteria ◽  
Prognostic Accuracy ◽  
Observational Cohort

BackgroundThe WHO and National Institute for Health and Care Excellence recommend various triage tools to assist decision-making for patients with suspected COVID-19. We aimed to compare the accuracy of triage tools for predicting severe illness in adults presenting to the ED with suspected COVID-19.MethodsWe undertook a mixed prospective and retrospective observational cohort study in 70 EDs across the UK. We collected data from people attending with suspected COVID-19 and used presenting data to determine the results of assessment with the WHO algorithm, National Early Warning Score version 2 (NEWS2), CURB-65, CRB-65, Pandemic Modified Early Warning Score (PMEWS) and the swine flu adult hospital pathway (SFAHP). We used 30-day outcome data (death or receipt of respiratory, cardiovascular or renal support) to determine prognostic accuracy for adverse outcome.ResultsWe analysed data from 20 891 adults, of whom 4611 (22.1%) died or received organ support (primary outcome), with 2058 (9.9%) receiving organ support and 2553 (12.2%) dying without organ support (secondary outcomes). C-statistics for the primary outcome were: CURB-65 0.75; CRB-65 0.70; PMEWS 0.77; NEWS2 (score) 0.77; NEWS2 (rule) 0.69; SFAHP (6-point rule) 0.70; SFAHP (7-point rule) 0.68; WHO algorithm 0.61. All triage tools showed worse prediction for receipt of organ support and better prediction for death without organ support. At the recommended threshold, PMEWS and the WHO criteria showed good sensitivity (0.97 and 0.95, respectively) at the expense of specificity (0.30 and 0.27, respectively). The NEWS2 score showed similar sensitivity (0.96) and specificity (0.28) when a lower threshold than recommended was used.ConclusionCURB-65, PMEWS and the NEWS2 score provide good but not excellent prediction for adverse outcome in suspected COVID-19, and predicted death without organ support better than receipt of organ support. PMEWS, the WHO criteria and NEWS2 (using a lower threshold than usually recommended) provide good sensitivity at the expense of specificity.Trial registration numberISRCTN56149622.

scholarly journals Post-exertion oxygen saturation as a prognostic factor for adverse outcome in patients attending the emergency department with suspected COVID-19: a substudy of the PRIEST observational cohort study

2020 ◽  
pp. emermed-2020-210528
Author(s):  
Steve Goodacre ◽  
Ben Thomas ◽  
Ellen Lee ◽  
Laura Sutton ◽  
Amanda Loban ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Oxygen Saturation ◽  
Adverse Outcome ◽  
Multivariable Analysis ◽  
Observational Cohort Study ◽  
Likelihood Ratios ◽  
Hospital Records ◽  
C Statistic ◽  
Observational Cohort

BackgroundMeasurement of post-exertion oxygen saturation has been proposed to assess illness severity in suspected COVID-19 infection. We aimed to determine the accuracy of post-exertional oxygen saturation for predicting adverse outcome in suspected COVID-19.MethodsWe undertook a substudy of an observational cohort study across 70 emergency departments during the first wave of the COVID-19 pandemic in the UK. We collected data prospectively, using a standardised assessment form, and retrospectively, using hospital records, from patients with suspected COVID-19, and reviewed hospital records at 30 days for adverse outcome (death or receiving organ support). Patients with post-exertion oxygen saturation recorded were selected for this analysis. We constructed receiver-operating characteristic curves, calculated diagnostic parameters, and developed a multivariable model for predicting adverse outcome.ResultsWe analysed data from 817 patients with post-exertion oxygen saturation recorded after excluding 54 in whom measurement appeared unfeasible. The c-statistic for post-exertion change in oxygen saturation was 0.589 (95% CI 0.465 to 0.713), and the positive and negative likelihood ratios of a 3% or more desaturation were, respectively, 1.78 (1.25 to 2.53) and 0.67 (0.46 to 0.98). Multivariable analysis showed that post-exertion oxygen saturation was not a significant predictor of adverse outcome when baseline clinical assessment was taken into account (p=0.368). Secondary analysis excluding patients in whom post-exertion measurement appeared inappropriate resulted in a c-statistic of 0.699 (0.581 to 0.817), likelihood ratios of 1.98 (1.26 to 3.10) and 0.61 (0.35 to 1.07), and some evidence of additional prognostic value on multivariable analysis (p=0.019).ConclusionsPost-exertion oxygen saturation provides modest prognostic information in the assessment of selected patients attending the emergency department with suspected COVID-19.Trial registration numberISRCTN Registry (ISRCTN56149622) http://www.isrctn.com/ISRCTN28342533.

scholarly journals Post-exertion oxygen saturation as a prognostic factor for adverse outcome in patients attending the emergency department with suspected COVID-19: Observational cohort study

2020 ◽  
Author(s):  
Steve Goodacre ◽  
Ben Thomas ◽  
Ellen Lee ◽  
Laura Sutton ◽  
Katie Biggs ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Oxygen Saturation ◽  
Adverse Outcome ◽  
Multivariable Analysis ◽  
Observational Cohort Study ◽  
Likelihood Ratios ◽  
Hospital Records ◽  
C Statistic ◽  
Observational Cohort

Background Measurement of post-exertion oxygen saturation has been proposed to assess illness severity in suspected COVID-19 infection. We aimed to determine the accuracy of post-exertional oxygen saturation for predicting adverse outcome in suspected COVID-19. Methods We undertook an observational cohort study across 70 emergency departments during first wave of the COVID-19 pandemic in the United Kingdom. We collected data prospectively, using a standardised assessment form, and retrospectively, using hospital records, from patients with suspected COVID-19, and reviewed hospital records at 30 days for adverse outcome (death or receiving organ support). Patients with post-exertion oxygen saturation recorded were selected for this analysis. Results We analysed data from 817 patients with post-exertion oxygen saturation recorded after excluding 54 in whom measurement appeared unfeasible. The c-statistic for post-exertion change in oxygen saturation was 0.589 (95% confidence interval 0.465 to 0.713), and the positive and negative likelihood ratios of a 3% or more desaturation were respectively 1.78 (1.25 to 2.53) and 0.67 (0.46 to 0.98). Multivariable analysis showed that post-exertion oxygen saturation was not a significant predictor of adverse outcome when baseline clinical assessment was taken into account (p=0.368). Secondary analysis excluding patients in whom post-exertion measurement appeared inappropriate resulted in a c-statistic of 0.699 (0.581 to 0.817), likelihood ratios of 1.98 (1.26 to 3.10) and 0.61 (0.35 to 1.07), and some evidence of additional prognostic value on multivariable analysis (p=0.019). Conclusions Post-exertion oxygen saturation provides modest prognostic information in the assessment of patients attending the emergency department with suspected COVID-19.

Interpretation of the QuickDASH score after open carpal tunnel decompression: threshold values associated with patient satisfaction

2016 ◽  
Vol 41 (6) ◽  
pp. 624-631 ◽  
Author(s):  
N. D. Clement ◽  
A. D. Duckworth ◽  
P. J. Jenkins ◽  
J. E. McEachan
Keyword(s):  
Cohort Study ◽  
Patient Satisfaction ◽  
Carpal Tunnel ◽  
Outcome Data ◽  
Observational Cohort Study ◽  
Baseline Score ◽  
Threshold Values ◽  
Level Of Evidence ◽  
Future Studies ◽  
Observational Cohort

We studied the correlation between change in the QuickDASH score and the absolute post-operative QuickDASH score with patient satisfaction after open carpal tunnel decompression. Threshold values in the QuickDASH score, the point at which the sensitivity and specificity are maximal in predicting patient satisfaction, were identified. During the study period, outcome data were compiled for 937 carpal tunnel decompressions, which included 219 (23%) male and 718 (77%) female patients with a mean age of 58 years (standard deviation (SD) 14). There was a significant improvement (mean difference 32, 95% confidence interval (CI) 30 to 34) in the QuickDASH from a mean of 54 (SD 20) to 22 (SD 23) at 1 year after surgery. There were 808 (86%) patients who defined their outcome as satisfactory at 1 year. The identified threshold values for the post-operative QuickDASH score (⩽34 points) and the change (⩾20 points) in the score were highly predictive of patient satisfaction. However, these threshold values varied significantly according to the baseline pre-operative score. The threshold values identified in the QuickDASH can be used to interpret the score. However, the influence of the pre-operative baseline score should be taken into account when comparing different cohorts of patients or using the values to power future studies. Level of Evidence IV: Prognosis, observational cohort study

scholarly journals Diagnostic Potential of Coagulation-Related Biomarkers for Sepsis in the Emergency Department: Protocol for a Pilot Observational Cohort Study

2021 ◽  
Vol 3 (4) ◽  
pp. e0414
Author(s):  
Jaskirat Arora ◽  
Jennifer A. Klowak ◽  
Sameer Parpia ◽  
Marcelo Zapata-Canivilo ◽  
Walaa Faidi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Observational Cohort Study ◽  
Diagnostic Potential ◽  
Observational Cohort
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