Abstract：
BACKGROUND: In the context of the COVID-19 pandemic, the early and accurate identification of patients at risk of deterioration was crucial in overcrowded and resource-limited emergency departments. This study conducts an external validation for the evaluation of the performance of the National Early Warning Score 2 (NEWS2), the S/F ratio, and the ROX index at ED admission in a large cohort of COVID-19 patients from Colombia, South America, assessing the net clinical benefit with decision curve analysis.
METHODS: A prospective cohort study was conducted on 6907 adult patients with confirmed COVID-19 admitted to a tertiary care ED in Colombia. The study evaluated the diagnostic performance of NEWS2, S/F ratio, and ROX index scores at ED admission using the area under the receiver operating characteristic curve (AUROC) for discrimination, calibration, and decision curve analysis for the prediction of intensive care unit admission, invasive mechanical ventilation, and in-hospital mortality.
RESULTS: We included 6907 patients who presented to the ED with confirmed SARS-CoV-2 infection from March 2020 to November 2021. Mean age was 51 (35-65) years and 50.4% of patients were males. The rate of intensive care unit admission was 28%, and in-hospital death was 9.8%. All three scores have good discriminatory performance for the three outcomes based on the AUROC. S/F ratio showed miscalibration at low predicted probabilities and decision curve analysis indicated that the NEWS2 score provided a greater net benefit compared to other scores across at a 10% threshold to decide ED admission at a high-level of care facility.
CONCLUSIONS: The NEWS2, S/F ratio, and ROX index at ED admission have good discriminatory performances in COVID-19 patients for the prediction of adverse outcomes, but the NEWS2 score has a higher net benefit underscoring its clinical utility in optimizing patient management and resource allocation in emergency settings.
METHODS: A prospective cohort study was conducted on 6907 adult patients with confirmed COVID-19 admitted to a tertiary care ED in Colombia. The study evaluated the diagnostic performance of NEWS2, S/F ratio, and ROX index scores at ED admission using the area under the receiver operating characteristic curve (AUROC) for discrimination, calibration, and decision curve analysis for the prediction of intensive care unit admission, invasive mechanical ventilation, and in-hospital mortality.
RESULTS: We included 6907 patients who presented to the ED with confirmed SARS-CoV-2 infection from March 2020 to November 2021. Mean age was 51 (35-65) years and 50.4% of patients were males. The rate of intensive care unit admission was 28%, and in-hospital death was 9.8%. All three scores have good discriminatory performance for the three outcomes based on the AUROC. S/F ratio showed miscalibration at low predicted probabilities and decision curve analysis indicated that the NEWS2 score provided a greater net benefit compared to other scores across at a 10% threshold to decide ED admission at a high-level of care facility.
CONCLUSIONS: The NEWS2, S/F ratio, and ROX index at ED admission have good discriminatory performances in COVID-19 patients for the prediction of adverse outcomes, but the NEWS2 score has a higher net benefit underscoring its clinical utility in optimizing patient management and resource allocation in emergency settings.
摘要：
背景：在COVID-19大流行的背景下，在过度拥挤且资源有限的急诊科,早期准确识别有恶化风险的患者至关重要.本研究对国家早期预警评分2（NEWS2）的绩效进行了外部验证，S/F比，和来自哥伦比亚的大量COVID-19患者在ED入院时的ROX指数，南美洲,通过决策曲线分析评估净临床效益。
方法：对哥伦比亚接受三级护理的6907例确诊为COVID-19的成年患者进行了前瞻性队列研究。该研究评估了NEWS2的诊断性能，S/F比，和ED入院时使用接受者工作特征曲线下面积（AUROC）进行区分的ROX指数得分，校准,和预测重症监护病房入院的决策曲线分析，有创机械通气，和住院死亡率。
结果：我们纳入了从2020年3月至2021年11月到急诊室确诊的SARS-CoV-2感染的6907名患者。平均年龄为51（35-65）岁，50.4％的患者为男性。重症监护病房的入院率为28%,住院死亡率为9.8%。基于AUROC，所有三个分数对三个结果都具有良好的歧视性表现。S/F比率在低预测概率下显示出错误校准，并且决策曲线分析表明，与其他分数相比，NEWS2分数在10％的阈值下提供了更大的净收益，以决定在高水平护理设施中的ED入院。
结论：NEWS2，S/F比，和ROX指数在COVID-19患者中对不良结局的预测具有良好的辨别表现，但NEWS2评分具有更高的净收益,这凸显了其在优化急诊患者管理和资源分配方面的临床效用.
方法：对哥伦比亚接受三级护理的6907例确诊为COVID-19的成年患者进行了前瞻性队列研究。该研究评估了NEWS2的诊断性能，S/F比，和ED入院时使用接受者工作特征曲线下面积（AUROC）进行区分的ROX指数得分，校准,和预测重症监护病房入院的决策曲线分析，有创机械通气，和住院死亡率。
结果：我们纳入了从2020年3月至2021年11月到急诊室确诊的SARS-CoV-2感染的6907名患者。平均年龄为51（35-65）岁，50.4％的患者为男性。重症监护病房的入院率为28%,住院死亡率为9.8%。基于AUROC，所有三个分数对三个结果都具有良好的歧视性表现。S/F比率在低预测概率下显示出错误校准，并且决策曲线分析表明，与其他分数相比，NEWS2分数在10％的阈值下提供了更大的净收益，以决定在高水平护理设施中的ED入院。
结论：NEWS2，S/F比，和ROX指数在COVID-19患者中对不良结局的预测具有良好的辨别表现，但NEWS2评分具有更高的净收益,这凸显了其在优化急诊患者管理和资源分配方面的临床效用.
