Aims To determine the prognostic usefulness of the National Early Warning Score‐2 (NEWS2) and quick Sepsis‐related Organ Failure Assessment (qSOFA) scores, in isolation and combined with capillary lactate (CL), using the new NEWS2‐L and qSOFA‐L scores to predict the 30‐day mortality risk. Methods Prospective, multicentre and observational study in patients across four EDs. We collected sets of vital signs and CL and subsequently calculated NEWS2, qSOFA, NEWS2‐L and qSOFA‐L scores when patients arrived at the ED. The main outcome measure was all‐cause mortality 30 days from the index event. Results A total of 941 patients were included. Thirty‐six patients (3.8%) died within 30 days of the index event. A high CL level has not been linked to a higher mortality. The NEWS2 presented AUROC of 0.72 (95% CI: 0.62‐0.81), qSOFA of 0.66 (95% CI: 0.56‐0.77) (P < .001 in both cases) and CL 0.55 (95% CI: 0.42‐0.65; P = .229) to predict 30‐day mortality. The addition of CL to the scores analysed does not improve the results of the scores used in isolation. Conclusion NEWS2 and qSOFA scores are a very useful tool for assessing the status of patients who come to the ED in general for all types of patients in triage categories II and III and for detecting the 30‐day mortality risk. CL determined systematically in the ED does not seem to provide information on the prognosis of the patients.

Aims To assess the prognostic accuracy of comorbidity‐adjusted National Early Warning Score in suspected Coronavirus disease 2019 patients transferred from nursing homes by the Emergency Department. Design Multicentre retrospective cohort study. Methods Patients transferred by high‐priority ambulances from nursing homes to Emergency Departments with suspected severe acute respiratory syndrome coronavirus 2 infection, from March 12 to July 31 2020, were considered. Included variables were: clinical covariates (respiratory rate, oxygen saturation, systolic blood pressure, heart rate, temperature, level of consciousness and supplemental oxygen use), the presence of comorbidities and confirmatory analytical diagnosis of severe acute respiratory syndrome coronavirus 2 infection. The primary outcome was a 2‐day mortality rate. The discriminatory capability of the National Early Warning Score was assessed by the area under the receiver operating characteristic curve in two different cohorts, the validation and the revalidation, which were randomly selected from the main cohort. Results A total of 337 nursing homes, 10 advanced life support units, 51 basic life support units and 8 hospitals in Spain entailing 1,324 patients (median age 87 years) was involved in this study. Two‐day mortality was 11.5% (152 cases), with a positivity rate of severe acute respiratory syndrome coronavirus 2 of 51.2%, 77.7% of hospitalization from whom 1% was of intensive care unit admission. The National Early Warning Score results for the revalidation cohort presented an AUC of 0.771, and of 0.885, 0.778 and 0.730 for the low‐, medium‐ and high‐level groups of comorbidities. Conclusion The comorbidity‐adjusted National Early Warning Score provides a good short‐term prognostic criterion, information that can help in the decision‐making process to guide the best strategy for each older adult, under the current pandemic. Impact What problem did the study address? Under the current coronavirus disease 2019 pandemic, targeting older adults at high risk of deterioration in nursing homes remains challenging. What were the main findings? Comorbidity‐adjusted National Early Warning Score helps to forecast the risk of clinical deterioration more accurately. Where and on whom will the research have impact? A high NEWS, with a low level of comorbidity is associated with optimal predictive performance, making these older adults likely to benefit from continued follow up and potentially hospital referral under the current coronavirus disease 2019 pandemic.

Introduction. Health and non-health workers (H&NH-W) in a hospital are more exposed to SARS-CoV-2 infection than the general population. We studied the prevalence of this infection in these workers of Segovia´s Hospital after the first epidemic wave. Material and methods. Monocentric, observational, cross-sectional study, carried out between April 29 and May 14, 2020. The infection was diagnosed by capillary immunochromatography test for IgG and / or IgM antibodies, or PCR. Work, health, and exposure variables were studied. Results. A total of 1,335 H&NH-W participated in the study out of a total of 1,667 (80.1%), 79.3% women, with a mean age of 47.3 years, and 47.1 for men. The prevalence of infected was 21.95%, 24.7% asymptomatic. Age presented a significant OR of 1.02/year. Exposure outside of work increased the prevalence by 16.8%. The continued use of Personal Protective Equipment (PPE) and the administration of nebulizations presented an OR of 0.54 and 0.46 respectively. The symptoms associated with the highest prevalence were anosmia (OR 9.31), ageusia (OR 3.05), and fever (OR 1.94). Today, about 75% of H&NH-W were infected in the first wave. Conclusions. The prevalence is higher among healthcare workers than the population they serve. Age is associated with a higher prevalence of infection. Almost a quarter of those infected were asymptomatic. The continuous use of PPE was associated with a lower prevalence, for that the administration of nebulisations could be safe. The symptoms with the greatest association were fever, anosmia, and ageusia.