Characterisation of 22445 patients attending UK emergency departments with suspected COVID-19 infection: Observational cohort study

Background Hospital emergency departments play a crucial role in the initial assessment and management of suspected COVID-19 infection. This needs to be guided by studies of people presenting with suspected COVID-19, including those admitted and discharged, and those who do not ultimately have COVID-19 confirmed. We aimed to characterise patients attending emergency departments with suspected COVID-19, including subgroups based on sex, ethnicity and COVID-19 test results. Methods and findings 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. Outcomes were admission to hospital, COVID-19 result, organ support (respiratory, cardiovascular or renal), and death, by record review at 30 days. Mean age was 58.4 years, 11200 (50.4%) were female and 11034 (49.6%) male. Adults (age >16 years) were acutely unwell (median NEWS2 score of 4), frequently had limited performance status (46.9%) and had high rates of admission (67.1%), COVID-19 positivity (31.2%), organ support (9.8%) and death (15.5%). Children had much lower rates of admission (27.4%), COVID-19 positivity (1.2%), organ support (1.4%) and death (0.3%). Similar numbers of men and women presented to the ED, but men were more likely to be admitted (72.9% v 61.4%), require organ support (12.2% v 7.7%) and die (18.2% v 13.0%). Black or Asian adults tended to be younger than White adults (median age 54, 50 and 67 years), were less likely to have impaired performance status (43.1%, 26.8% and 51.6%), be admitted to hospital (60.8%, 57.3%, 69.6%) or die (11.6%, 11.2%, 16.4%), but were more likely to require organ support (15.9%, 14.3%, 8.9%) or have a positive COVID-19 test (40.8%, 42.1%, 30.0%). Adults admitted with suspected and confirmed COVID-19 had similar age, performance status and comorbidities (except chronic lung disease) to those who did not have COVID-19 confirmed, but were much more likely to need organ support (22.2% v 8.9%) or die (32.1% v 15.5%). Conclusions Important differences exist between patient groups presenting to the emergency department with suspected COVID-19. Adults and children differ markedly and require different approaches to emergency triage. Admission and adverse outcome rates among adults suggest that policies to avoid unnecessary ED attendance achieved their aim. Subsequent COVID-19 confirmation confers a worse prognosis and greater need for organ support. Registration ISRCTN registry, ISRCTN56149622, http://www.isrctn.com/ISRCTN28342533.

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Characterisation of 22446 patients attending UK emergency departments with suspected COVID-19 infection: Observational cohort study

10.1101/2020.08.10.20171496 ◽

2020 ◽

Cited By ~ 1

Author(s):

Steve Goodacre ◽

Ben Thomas ◽

Ellen Lee ◽

Laura Sutton ◽

Amanda Loban ◽

...

Keyword(s):

Cohort Study ◽

Emergency Departments ◽

Observational Cohort Study ◽

Organ Support ◽

Adult Men ◽

The United Kingdom ◽

Observational Cohort ◽

Patient Groups ◽

Hospital Emergency Departments ◽

Record Review

Background Hospital emergency departments play a crucial role in the initial management of suspected COVID-19 infection. We aimed to characterise patients attending emergency departments with suspected COVID-19, including subgroups based on sex, ethnicity and COVID-19 test results. 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 22446 people attending with suspected COVID-19 between 26 March 2020 and 28 May 2020. Outcomes were admission to hospital, COVID-19 result, organ support (respiratory, cardiovascular or renal), and death, by record review at 30 days. Results Adults were acutely unwell (median NEWS2 score 4) and had high rates of admission (67.1%), COVID-19 positivity (31.2%), organ support (9.8%) and death (15.9%). Children had much lower rates of admission (27.4%), COVID-19 positivity (1.2%), organ support (1.4%) and death (0.3%). Adult men and women presented in similar numbers (10210 versus 10506), but men were more likely to be admitted (72.9% v 61.4%), require organ support (12.2% v 7.7%) and die (18.7% v 13.3%). Black or Asian adults tended to be younger than White adults (median age 54, 50 and 67 years), were less likely to be admitted (60.8%, 57.3%, 69.6%) or die (11.9%, 11.2%, 16.8%), but were more likely to require organ support (15.9%, 14.3%, 8.9%) or have a positive COVID-19 test (40.8%, 42.1%, 30.0%). Adults admitted with confirmed COVID-19 had similar age and comorbidities (except chronic lung disease) to those who did not have COVID-19 confirmed, but were much more likely to need organ support (22.2% v 8.9%) or die (32.7% v 15.9%). Conclusions Important differences exist between patient groups presenting to the emergency department with suspected COVID-19. People with confirmed COVID-19 have a poor prognosis, compared with similar emergency admissions without confirmed COVID-19.

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1731 Epidemiology, severity and outcomes of children presenting to emergency departments across Europe during the SARS-COV-2 pandemic: an observational cohort study

10.1136/archdischild-2021-rcpch.816 ◽

2021 ◽

Author(s):

Ruud Nijman ◽

Kate Honeyford ◽

Silvia Bressan ◽

Luigi Titomanlio ◽

Keyword(s):

Cohort Study ◽

Emergency Departments ◽

Observational Cohort Study ◽

Observational Cohort

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Surprise Question and Performance Status Indicate Urgency of Palliative Care Needs in Patients with Advanced Cancer at the Emergency Department: An Observational Cohort Study

Journal of Palliative Medicine ◽

10.1089/jpm.2019.0413 ◽

2020 ◽

Vol 23 (6) ◽

pp. 801-808

Author(s):

Mary-Joanne Verhoef ◽

Ellen J.M. de Nijs ◽

Marta Fiocco ◽

Christian Heringhaus ◽

Nanda Horeweg ◽

...

Keyword(s):

Emergency Department ◽

Palliative Care ◽

Cohort Study ◽

Performance Status ◽

Observational Cohort Study ◽

Care Needs ◽

Observational Cohort ◽

And Performance ◽

Surprise Question ◽

Palliative Care Needs

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

10.1101/2020.10.12.20209809 ◽

2020 ◽

Cited By ~ 1

Author(s):

Steve Goodacre ◽

Ben Thomas ◽

Laura Sutton ◽

Matthew Bursnall ◽

Ellen Lee ◽

...

Keyword(s):

Cohort Study ◽

Adverse Outcome ◽

Performance Status ◽

Multivariable Analysis ◽

Clinical Score ◽

Observational Cohort Study ◽

Link Type ◽

Observational Cohort ◽

And Performance ◽

Ill Adults

AbstractObjectivesWe 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.MethodsWe 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.ResultsWe 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.ConclusionA 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.RegistrationISRCTN registry, ISRCTN28342533, http://www.isrctn.com/ISRCTN28342533

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

Emergency Medicine Journal ◽

10.1136/emermed-2020-210783 ◽

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.

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

PLoS ONE ◽

10.1371/journal.pone.0245840 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245840 ◽

Cited By ~ 1

Author(s):

Steve Goodacre ◽

Ben Thomas ◽

Laura Sutton ◽

Matthew Burnsall ◽

Ellen Lee ◽

...

Keyword(s):

Cohort Study ◽

Adverse Outcome ◽

Performance Status ◽

Multivariable Analysis ◽

Clinical Score ◽

Observational Cohort Study ◽

Clinical Severity ◽

Observational Cohort ◽

And Performance ◽

Ill Adults

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, ISRCTN28342533, http://www.isrctn.com/ISRCTN28342533

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Prognostic Value of Bioactive Adrenomedullin in Critically Ill Patients with COVID-19 in Germany: An Observational Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm10081667 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1667

Author(s):

Tim-Philipp Simon ◽

Christian Stoppe ◽

Thomas Breuer ◽

Lara Stiehler ◽

Michael Dreher ◽

...

Keyword(s):

Cohort Study ◽

Risk Stratification ◽

Critically Ill ◽

Plasma Levels ◽

Clinical Management ◽

Prognostic Value ◽

Observational Cohort Study ◽

Organ Support ◽

Early Risk ◽

Observational Cohort

The coronavirus disease 2019 (COVID-19) pandemic has placed a significant burden on hospitals worldwide. Objective biomarkers for early risk stratification and clinical management are still lacking. The aim of this work was to determine whether bioactive adrenomedullin can assist in the risk stratification and clinical management of critically ill COVID-19 patients. Fifty-three patients with confirmed COVID-19 were included in this prospective observational cohort study between March and April 2020. Bioactive adrenomedullin (bio-ADM) plasma concentration was measured daily for seven days after admission. The prognostic value and clinical significance of bio-ADM plasma levels were evaluated for the severity of respiratory failure, the need for extracorporeal organ support and outcome (28-day mortality). Bio-ADM levels increased with the severity of acute respiratory distress syndrome (ARDS; p < 0.001) and were significantly elevated in invasively ventilated patients (p = 0.006) and patients in need of extracorporeal membrane oxygenation (p = 0.040) or renal replacement therapy (RRT; p < 0.001) compared to patients without these conditions. Non-survivors showed significantly higher bio-ADM levels than survivors (p = 0.010). Bio-ADM levels predicted 28-day mortality (C-index 0.72, 95% confidence interval 0.56–0.87, p < 0.001). Bio-ADM plasma levels correlate with disease severity, the need for extracorporeal organ assistance, and outcome, and highlight the promising value of bio-ADM in the early risk stratification and management of patients with COVID-19.

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