COVID-19: risk stratification tool shows promise, especially in nonelderly

  • Hu H & al.
  • Acad Emerg Med
  • 20 Apr 2020

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • Applying the Rapid Emergency Medicine Score (REMS) to COVID-19 patients age 
  • Prospective validation is needed.

Why this matters

  • An accurate rapid scoring system could ease treatment and disposition decisions early in the course of COVID-19 presentations.
  • The previously developed REMS and Modified Early Warning Score (MEWS) use clinical variables like BP and oxygen saturation to aid in emergency department prognostication.
  • This study applied them to COVID-19 patients. 

Key results

  • Area under the curve (95% CIs):
    • MEWS: 0.677 (0.579-0.765).
    • REMS: 0.841 (0.757-0.905); difference, P=.028.
    • MEWS in subgroup age 
    • REMS in subgroup age 
  • Negative predictive value:
    • MEWS, with cutoff score of 2: 90.32%.
    • REMS, with cutoff score of 6: 96.77%.
  • Performance for patients age ≥65 was similar and modest for both tools.

Study design

  • Retrospective medical record review of critically ill adults in China on a COVID-19 ward (n=105).
  • Authors extracted baseline demographic and clinical data to calculate prognostic scores using MEWS and REMS.
  • Outcomes: in-hospital death. 
  • Funding: Sichuan University.

Limitations

  • Small single-center study subject to selection bias.