COVID-19: Asociación entre la clasificación de riesgo y el Modified Early Warning Score y los resultados hospitalarios / COVID-19: Association of risk classification with the Modified Early Warning Score and hospital outcomes / COVID-19: Associação da classificação de risco com o Modified Early Warning Score e os desfechos hospitalares

Objetivo: evaluar la asociación entre las categorías de clasificación de riesgo y el Modified Early Warning Score y los resultados de los pacientes con COVID-19 en el servicio de emergencia Método: estudio transversal, realizado con 372 pacientes hospitalizados con diagnóstico de COVID-19 atendidos en la Recepción con Clasificación de Riesgo en Urgencias. En este estudio, el Modified Early Warning Score de los pacientes se clasificó como sin y con deterioro clínico, de 0 a 4 y de 5 a 9, respectivamente. Se consideró que había deterioro clínico cuando presentaban insuficiencia respiratoria aguda, shock y paro cardiorrespiratorio. Resultados: el Modified Early Warning Score promedio fue de 3,34. En cuanto al deterioro clínico de los pacientes, se observó que en el 43% de los casos el tiempo de deterioro fue menor a 24 horas y que el 65,9% ocurrió en urgencias. El deterioro más frecuente fue la insuficiencia respiratoria aguda (69,9%) y el resultado fue alta hospitalaria (70,3%). Conclusión: los pacientes con COVID-19 que presentaban Modified Early Warning Score 4 se asociaron a las categorías de clasificación de riesgo urgente, muy urgente y emergente y tuvieron más deterioro clínico, como insuficiencia respiratoria y shock, y murieron, lo que demuestra que el Protocolo de Clasificación de Riesgo priorizó correctamente a los pacientes con riesgo vital.

Objective: to evaluate the association of the risk classification categories with the Modified Early Warning Score and the outcomes of COVID-19 patients in the emergency service Method: a crosssectional study carried out with 372 patients hospitalized with a COVID-19 diagnosis and treated at the Risk Classification Welcoming area from the Emergency Room. In this study, the patients' Modified Early Warning Score was categorized into without and with clinical deterioration, from 0 to 4 and from 5 to 9, respectively. Clinical deterioration was considered to be acute respiratory failure, shock and cardiopulmonary arrest Results: the mean Modified Early Warning Score was 3.34. In relation to the patients' clinical deterioration, it was observed that, in 43%, the time for deterioration was less than 24 hours and that 65.9% occurred in the Emergency Room. The most frequent deterioration was acute respiratory failure (69.9%) and the outcome was hospital discharge (70.3%). Conclusion: COVID-19 patients who had a Modified Early Warning Scores > 4 were associated with the urgent, very urgent and emergency risk classification categories, had more clinical deterioration, such as respiratory failure and shock, and evolved more to death, which shows that the Risk Classification Protocol correctly prioritized patients at risk of life.

Objetivo: avaliar a associação das categorias de classificação de risco com o Modified Early Warning Score e os desfechos dos pacientes com COVID-19 no serviço de emergência Método: estudo transversal, realizado com 372 pacientes internados com diagnóstico de COVID-19 atendidos no Acolhimento com Classificação de Risco no Pronto-Atendimento. Neste estudo, o Modified Early Warning Score dos pacientes foi categorizado em sem e com deterioração clínica, de 0 a 4 e de 5 a 9, respectivamente. Foram consideradas deteriorações clínicas a insuficiência respiratória aguda, choque e parada cardiorrespiratória. Resultados: o Modified Early Warning Score médio foi de 3,34. Em relação à deterioração clínica dos pacientes, observou-se que em 43% o tempo para deterioração foi menor de 24 horas e que 65,9% delas ocorreu no pronto-socorro. A deterioração mais frequente foi a insuficiência respiratória aguda (69,9%) e o desfecho foi o de alta hospitalar (70,3%). Conclusão: pacientes com COVID-19 que tiveram Modified Early Warning Score 4 foram associados às categorias da classificação de risco urgente, muito urgente e emergente e tiveram mais deterioração clínica, como a insuficiência respiratória e o choque, e evoluíram mais a óbito, o que demonstra que o Protocolo de Classificação de Risco priorizou corretamente os pacientes com risco de vida.

Early warning scores to identify the risk of clinical worsening or death in patients hospitalized for COVID-19

Background: identifying patients at risk for negative outcomes is key for performing a timely triage and adapting the care intensity for patients with COVID-19. Early warning scores are rules that alert to the risk of adverse outcomes during hospitalization. We sought to validate the modified NEWS, NEWS-2 and COVID-19 Severity Index (CSI). Methods: a prospective observational multicenter study of patients hospitalized for CO VID-19 at three quaternary care hospitals in Bogotá, Colombia, between April and November 2020. The operating characteristics and areas under the ROC curve were calculated. Results: 711 patients were included, in whom the AUC for death was 0.68, 0.58 and 0.68, and for ICU admission was 0.61, 0.63 and 0.66 for mNEWS, NEWS-2 and CSI, respectively. The CSI had the greatest sensitivity for ICU admission or death (87.6 and 90.0%) and NEWS-2 had the greatest specificity (76.8 and 75.5%). Conclusions: the three early warning scores had a low to moderate performance in pre dicting ICU admission or death in patients hospitalized for COVID-19. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2225).

Antecedentes: la identificación de los pacientes con riesgo de desenlaces negativos es clave para realizar un triage oportuno y adecuar la intensidad de los cuidados en los pacientes con COVID-19. Las puntuaciones de alerta temprana son reglas para advertir el riesgo de desenlaces adversos durante la hospitalización. Buscamos validar el NEWS modificado, NEWS-2 y COVID-19 Severity Index. Metodología: estudio observacional, prospectivo, multicéntrico con pacientes hospitalizados por COVID-19 en tres hospitales de cuarto nivel en Bogotá (Colombia), entre abril y noviembre de 2020. Se calcularon las características operativas y áreas bajo la curva ROC. Resultados: se contó con 711 pacientes entre los cuales el AUC para muerte fue 0.68, 0.58 y 0.68, y para ingreso a UCI de 0.61, 0.63 y 0.66 para NEWSm, NEWS-2 y CSI respectivamente. El CSI alcanzó la mayor sensibilidad para ingreso a UCI o muerte (87.6 y 90.0%) y la mayor especificidad fue el NEWS-2 (76.8 y 75.5%). Conclusiones: las tres puntuaciones de alerta temprana mostraron un desempeño bajo a moderado para la predicción del ingreso a UCI o muerte en pacientes hospitalizados por COVID-19. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2225).

The effect of modified early warning scores on nosocomial emergency transshipment in primary hospital / 中国基层医药

Objective To investigate the effect of modified early warning scores (MEWS)on nosocomial emergency transshipment in primary hospital.Methods From July 2013 to February 2014,192 patients were selected as control group,and from March 2014 to October 2014,192 patients were selected as observation group.The control group conducted assessment and transshipment by experience.The observation group adopted MEWS to evaluate dis-ease and applied targeted treatment.Then,we compared the incidence of unsafe events,accuracy of handover,family member and the related departments 'satisfaction.Results After the implementation of MEWS,the incidence of unsafe events was decreased from 13.0% to 5.2%(χ2 =5.121 ).The accuracy of handover was increased from 85.4% to 94.3% (χ2 =8.248).The family member and related departments 'satisfaction were improved from 89.1%,87.5% to 97.4% and 96.4%,respectively (χ2 =15.561,χ2 =10.141).The differences were statistically significant (P <0.05).Conclusion MEWS can evaluate and classify the safety of patients objectively and effective-ly during nosocomial emergency transshipment.MWES can effectively reduce the incidence of unsafe events,increase the accuracy of handover,improve family member and related departments'satisfaction.

Clinical application of modified early warning scores assessing the conditions and prognosis of pre-hospital acute poisoning / 中华急诊医学杂志

Objective To study the significance and feasibility of modified early warning scores (MEWS) assessing the conditions and death prediction among the pre-hospital acute poisoning patients.Methods We performed a prospective,observational study of the pre-hospital acute poisoning patients between January 1,2010 and December 31,2010.Data was collected to calculate the MEWS.Numeration data was presented in percentage by using chi-square test,and measurement data was expressed in mean with standard deviation,and P ＜ 0.05 was considered to be different with statistical significance.Observation lasted for 90 days after admission to get the results as observation index and ROC was drew and the area under the curve and the predicting index were calculated.The patients without vital signs and unsuccessful resuscitation were not included in this study.Results It showed 287 person times with 0 ～ 6 scores,accounting 94.4％,17 person times with 7-13 scores,accounting 5.59％,among the dead patients,MEWS were more than those of the survival group with statistical significance (P ＜ 0.05).The area under ROC was 0.99 indicating that MEWS≥7 was the board line for severe pre-hospital acute poisoning patients with sensitivity of 91.7％,specificity of 97.9％,accuracy of 97.7％ and Youden of 0.896 for predicting death.It showed high significance of the application of MEWS in assessing acute poisoning patients and death prediction.Conclusions MEWS assess pre-hospital acute poisoning patients and predict death with good resolution and strong application significance,which is simple,practical and applicable.

Clinical value of modified early warning score in assessing the conditions and prognosis of prehospital trauma / 中华急诊医学杂志

Objective To study the feasibility of modified early warning scores (MEWS) for assessing the severity and death prediction in the pre-hospital traumatic patients.MethodsData of the prehospital traumatic patients admitted between January 1,2010 and December 31,2010 were collected and assessed onsite by using MEWS.Numeration data was presented in percentage by using chi-square test,and measurement data was xepressed in mean with standard deviation,and P ＜ 0.05 was considered to be difference with statistical significance.Observation was lasted for 90 days after admission to get final results as observation object and ROC curve was drew and calculated the area under the curve for predicting severity and death of patients.The patients without vital signs and unsuccessful resuscitations were not included in this study.ResultsThere were 1475 (87.95％) cases/times with score of 0 -2,and 202 (12.05％)cases/times with score of 3 - 13.In the non-survival group,MEWS were higher than that in the survival group with statistic significance ( P ＜ 0.01 ).When the area under ROC was 0.94,the optimal cutoff point for potentially severe patients was MEWS≥3 for predicting the death of severe pre-hospital traumatic patients with sensitivity of 85.7％,specificity of 88.6％,accuracy of 88.6％ and Youden of 0.743,showing high significance of the application of MEWS to assessing severity of traumatic patients and death prediction.ConclusionsMEWS used to assess the pre-hospital traumatic patients and predict death with high validity and accurate quantification is a simple,practical and easily operable method with strong application significance.