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Prognostic accuracy of triage tools for adults with suspected COVID-19 in a middle-income setting
Emergency Medicine Journal : EMJ ; 39(12):A976-A977, 2022.
Article in English | ProQuest Central | ID: covidwho-2137856
ABSTRACT
1482 Figure 2Performance of tools predicting composite primary outcome for the Omicron period[Figure omitted. See PDF] 1482 Table 1Triage tool diagnostic accuracy statistics (95% CI) for predicting any adverse outcome (entire study period)Tool N* C-statistic Threshold N (%) above threshold Sensitivity Specificity PPV NPV CRB-65 432,584 0.70 (0.70, 0.71) >0 102,964 (23.8%) 0.61 (0.61, 0.61) 0.78 (0.77, 0.78) 0.09 (0.09, 0.09) 0.98 (0.98, 0.98) NEWS2 433,101 0.80 (0.79, 0.80) >1 178835 (41.3%) 0.83 (0.83, 0.83) 0.6 (0.6,0.6) 0.07 (0.07–0.07) 0.99 (0.99, 0.99) PMEWS 438,810 0.79 (0.79, 0.79) >2 199,386 (45.4%) 0.85 (0.85, 0.85) 0.56 (0.56, 0.56) 0.06 (0.06, 0.07) 0.99 (0.99,0.99) PRIEST 438,880 0.82 (0.82, 0.82) >4 158,893 (36.2%) 0.83 (0.83, 0.83) 0.65 (0.65,0.66) 0.08 (0.08, 0.08) 0.99 (0.99, 0.99) WHO 437,850 0.71 (0.71, 0.72) >0 235,775 (53.8%) 0.82 (0.81, 0.82) 0.47 (0.47, 0.47) 0.05 (0.05, 0.05) 0.99 (0.99, 0.99) TEWS 432,612 0.72 (0.71, 0.72) >2 134,097 (31%) 0.62 (0.62, 0.62) 0.70 (0.70, 0.70) 0.07 (0.07, 0.07) 0.98 (0.98, 0.98) Quick COVID 446,088 0.70 (0.69, 0.70) >3 35,145 (7.9%) 0.33 (0.33, 0.33) 0.93 (0.93, 0.93) 0.14 (0.14, 0.14) 0.98 (0.98, 0.98) *Patients with <3 parameters were excluded from analysis when estimating performance 1482 Table 2Triage tool diagnostic accuracy statistics (95% CI) for predicting any adverse outcome (Omicron period)Tool N* C-statistic Threshold N (%) above threshold Sensitivity Specificity PPV NPV CRB-65 136,961 0.69 (0.68, 0.70) >0 31,373 (22.9%) 0.59 (0.59, 0.59) 0.78 (0.78, 0.78) 0.05 (0.05, 0.05) 0.99 (0.99, 0.99) NEWS2 137,125 0.77 (0.76, 0.78) >1 76,183 (55.6%) 0.87 (0.87, 0.87) 0.45 (0.45, 0.45) 0.03 (0.03, 0.03) 0.99 (0.99, 0.99) PMEWS 138,954 0.76 (0.75, 0.76) >2 59,876 (43.1%) 0.80 (0.80, 0.80) 0.58 (0.58, 0.58) 0.04 (0.04, 0.04) 0.99 (0.99, 0.99) PRIEST 158,893 0.78 (0.77, 0.79) >4 46,529 (33.5%) 0.75 (0.75, 0.75) 0.67 (0.67, 0.67) 0.04 (0.04, 0.04) 0.99 (0.99, 0.99) WHO 138,666 0.62 (0.61, 0.63) >0 72,599 (52.4%) 0.70 (0.70, 0.70) 0.48 (0.48, 0.48) 0.03 (0.03, 0.03) 0.99 (0.99, 0.99) TEWS 136,967 0.73 (0.72, 0.74) >2 39,509 (28.8%) 0.64 (0.64, 0.64) 0.72 (0.72, 0.72) 0.04 (0.04, 0.04) 0.99 (0.99, 0.99) Quick COVID 140520 0.61 (0.60, 0.63) >3 8,210 (6.4%) 0.17 (0.17, 0.17) 0.94 (0.94, 0.94) 0.06 (0.06, 0.06) 0.98 (0.98, 0.98) *Patients with <3 parameters were excluded from analysis when estimating performanceResults and ConclusionOf the 446,084 patients, 15,397 patients (3.45%, 95% CI34% to 35.1%) experienced the primary outcome. Figure 1 presents the ROC curves for the triage tools for the total study period and figure 2 for the period of the Omicron wave. NEWS2, PMEWS, PRIEST tool and WHO algorithm identified patients at risk of adverse outcomes at recommended cut-offs with moderate sensitivity (>0.8) and specificity ranging from 0.47 (NEWS2) o 0.65 (PRIEST tool). The low prevalence of the primary outcome, especially in the Omicron period, meant use of these tools would have more than doubled admissions with only a small reduction in risk of false negative triage.Triage tools developed specifically in low- and middle-income settings may be needed to provide accurate risk prediction. Existing triage tools may need to be used at varying thresholds to reflect different baseline-line risks of adverse outcomes in different settings.
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Full text: Available Collection: Databases of international organizations Database: ProQuest Central Type of study: Prognostic study Language: English Journal: Emergency Medicine Journal : EMJ Year: 2022 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: ProQuest Central Type of study: Prognostic study Language: English Journal: Emergency Medicine Journal : EMJ Year: 2022 Document Type: Article