Seven Criteria of Severe COVID-19 (SCSC): A New Pre-Hospital Prognostic Scoring Tool Suggested for Screening of Probable/Confirmed COVID-19 Patients with Severe Outcomes

Abstract

Introduction: COVID-19 pandemic led to various consequences in medical care that had been long provided for the patients referred to the hospitals.
 Objective: We conducted this study to derive and validate a new scoring system that can accurately differentiate COVID-19 patients who may have a worse outcome from others at the prehospital stage.
 Methods: This study was performed on probable/confirmed COVID-19 patients, who were transferred to the hospitals by Tehran emergency medical services (EMS). Occurrence of one of the items including: in-hospital death, intensive care unit (ICU) admission, or hospitalization for more than 20 days was considered to indicate a “severe disease”. Univariate and multivariate logistic regression were used for assessment of the relationship between all independent variables and the outcome. In the validity assessment step, area under the receiver operating characteristic (ROC) curve was calculated for a data set independent from the data based on which the model was designed. The sensitivity and specificity were also presented based on the best suggested cutoff point.
 Results: In this study, the data of 557 cases were analyzed in the derivation step and 356 cases were assessed in the validation step. The univariate logistic regression showed that age, weakness and fatigue, disease history, systolic blood pressure, SpO2, respiratory rate, and Glasgow coma scale (GCS) were statistically significant in severe disease group. The area under the ROC curve (AUC-ROC) of the tool was 0.808 (95% CI: 0.779, 0.834). The best cut-off point for screening was the score of ≥4, in which the sensitivity and specificity of the tool for the best cut-off point were 71.87% and 78.06%, respectively. In the validation step, the AUCROC of the tool was 0.723.
 Conclusions: Seven criteria of severe COVID-19 (SCSC) tool could properly differentiate probable/confirmed COVID-19 patients with severe outcomes in the pre-hospital stage.

Emergency medical service interventions and experiences during pandemics: A scoping review

“…According to their findings, initial vital signs (with the exception of body temperature) [ 82 ], prehospital triage tools [ 81 ], and telephone screening processes/surveillance tools used by emergency medical dispatchers [ 46 , 65 , 77 , 80 ] had little to moderate predictive value for the identification of COVID-19 patients and/or death.…”

The National Early Warning Score on admission predicts severe disease and in‐hospital mortality of the coronavirus disease 2019 Delta variant: A retrospective cohort study

“…The NEWS is widely used in clinical practice. Furthermore, in the context of COVID‐19, the NEWS has so far been evaluated, 6 , 7 , 8 but the population of these studies were selected from March 2020 to April 2020 when the Delta variant did not exist. In this study, compared with COVID‐19 wild type, the NEWS showed comparable prediction accuracy for severe disease caused by the Delta variant.…”

“…Traditional clinical risk stratification tools are widely used for triage and continuous assessment of patients with severe infectious diseases. Several studies have evaluated the use of these tools in patients with SARS‐CoV‐2 infection with variable results 6–11 . Furthermore, it has been confirmed that the severity prediction ability of the National Early Warning Score (NEWS) 6–8 and NEWS2 9,10 is significant.…”

“…Several studies have evaluated the use of these tools in patients with SARS‐CoV‐2 infection with variable results 6–11 . Furthermore, it has been confirmed that the severity prediction ability of the National Early Warning Score (NEWS) 6–8 and NEWS2 9,10 is significant.…”