The Ability of Early Warning Scores to Predict in Hospital Mortality and
ICU Admission for Patients with Covid 19 Pneumonia in the Emergency
Department
Abstract
Introduction: Early recognition of critical patients in crowded
environments such as emergency departments is required in Covid 19
pandemic and many early recognition scoring systems are used. In this
study, we aimed to determine the prognostic values of these scoring
systems. Material and method: This retrospective study was performed
between March 2020 -May 2020 and 212 patient who have Covid 19 pneumonia
were enrolled the study. National Early Warning Score (NEWS), Modified
Early Warning Score (MEWS) and quick Sequential Organ Failure Assessment
(qSOFA) scores were calculated at the time of admission to the emergency
department. Demographic data, mortality, intensive care unit (ICU)
admission rates and the prognostic values of the scores were calculated.
Receiver operating characteristic (ROC) analysis was used to determine
the diagnostic values of scores and the optimum cut-off values were
determined by using Youden Index. Results: 23 (10.8%) of 212 patients
died and 34 (16%) were admitted to ICU. The AUC values of MEWS, NEWS,
and qSOFA for predicting mortality in < 65 years old were
0.852 (95% confidence interval 0.708-0.997), 0.882(0.741-1.000) and
0.879(0.768-0.990) and >65 years old, 0.854(0.720-0.987),
0.931(0.853-1.000), 0.776(0.609-0.944) respectively. For ICU admission
AUC values of MEWS, NEWS and qSOFA in <65 years old followed
as; 0.882(0.783-0.981), 0.914(0.817-1.000), 0.868(0.764-0.973) and
0.845(0.725-0.965), 0.926(0.854-0.998), 0.815(0.676-0.954) in ≥ 65 years
old. While < 65 years old; MEWS and qSOFA’s optimal cut-off
values for mortality were ≥2 with %90.0 sensitivity %74.7 specificity
and ≥1 with %90.0 sensitivity %74.7 specificity, for ≥ 65 years NEWS
optimal cut-off is ≥6 with 91.7% sensitivity and 76.7% specificity.
Conclusion: All these three scores have good predictive value for
mortality and ICU admission, but NEWS is better than MEWS and qSOFA
especially in ≥ 65 years old patient with Covid 19 pneumonia.