The role of emergency department triage early warning score (TREWS) and modified early warning score (MEWS) to predict in-hospital mortality in COVID-19 patients

Abstract

Background It is necessary to identify critical patients requiring hospitalization early due to the rapid increase in the number of COVID-19 cases. Aim This study aims to evaluate the effectiveness of scoring systems such as emergency department triage early warning score (TREWS) and modified early warning score (MEWS) in predicting mortality in COVID-19 patients. Methods In this retrospective cohort study, PCR positive patients evaluated for COVID-19 and decided to be hospitalized were evaluated. During the first evaluation, MEWS and TREWS scores of the patients were calculated. Intensive care needs as well as 24-h and 28-day mortality rates were evaluated. Results A total of 339 patients were included in the study. While 30 (8.8%) patients were hospitalized in the intensive care unit, 4 (1.2%) died in the emergency. The number of patients who died within 28 days was found to be 57 (16.8%). In 24-h mortality, the median MEWS value was found to be 7 (IQR 25–75) while the TREWS value was 11.5 (IQR 25–75). In the ROC analysis made for the diagnostic value of 28-day mortality of MEWS and TREWS scores, the area under the curve (AUC) for the MEWS score was found to be 0.833 (95% CI 0.777–0.888, p < 0.001) while it was identified as 0.823 (95% CI 0.764–0.882, p < 0.001) for the TREWS. Conclusion MEWS and TREWS calculated at emergency services are effective in predicting 28-day mortality in patients requiring hospitalization due to COVID-19.

Analysis of Risk Factors for In-Hospital Death Due to COVID-19 in Patients Hospitalised at the Temporary Hospital Located at the National Stadium in Warsaw: A Retrospective Analysis

“…In their study, Tu et al demonstrated that the mortality of COVID-19 patients who required mechanical ventilation was high and that a delayed mechanical ventilation initiation was an independent predictor of the 28-day mortality of COVID-19 patients [ 48 ]. The findings from a study by Aygun and Eraybar showed that a group of COVID-19 patients who died had a significantly higher MEWS compared with a surviving group [ 49 ].…”

Neurological Prognostic Factors in Hospitalized Patients with COVID-19

“…A larger Chinese study comparing five different early warning scores in COVID-19 patients showed that the MEWS, when measured on admission, did not predict death risk [ 25 ]. On the other hand, a Turkish study revealed that the MEWS score calculated in the emergency room effectively predicted death in the forthcoming 28 days in patients with COVID-19 who required hospitalization [ 26 ]. The results of this study were in line with findings from a large cohort of 1000 patients from five Dutch hospitals [ 45 ].…”

“…In Poland, where more than 4 million cases with SARS-CoV-2 infection were noted as of 22 January 2022 [ 1 ], the easy to obtain Modified Early Warning Score (MEWS) was extensively used in clinical practice in accordance with national COVID-19 guidelines presented at the beginning of the pandemic [ 24 ]. However, there is limited data on the prognostic significance of the MEWS score in patients with COVID-19, and available studies produced divergent results [ 25 , 26 , 27 ].…”

Comparison of Different Scoring Systems for Prediction of Mortality and ICU Admission in Elderly CAP Population

“…It has been proven to be a crucial tool for early identification of patients with high risk of poor outcome. 24 , 39 , 40 In elderly COVID-19 patients, Wang et al 41 identified MEWS as an efficient tool for rapid assessment and the ROC analysis (AUC = 0.913) suggested that the MEWS was capable of predicting in-hospital mortality. Although MEWS has been found to be useful in elderly COVID-19 patients, 40 , 41 it has rarely been used in older adults with community-acquired pneumonia (CAP).…”

“… 24 , 39 , 40 In elderly COVID-19 patients, Wang et al 41 identified MEWS as an efficient tool for rapid assessment and the ROC analysis (AUC = 0.913) suggested that the MEWS was capable of predicting in-hospital mortality. Although MEWS has been found to be useful in elderly COVID-19 patients, 40 , 41 it has rarely been used in older adults with community-acquired pneumonia (CAP). In our research, we found that the AUC of MEWS for in-hospital mortality is 0.927, which is higher than the other scores (p < 0.01).…”