Development and validation of an early warning score to identify COVID-19 in the emergency department based on routine laboratory tests: a multicentre case-control study.
In: BMJ open, Jg. 12 (2022-08-03), Heft 8, S. e059111
Online
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Zugriff:
Objectives: Identifying patients with a possible SARS-CoV-2 infection in the emergency department (ED) is challenging. Symptoms differ, incidence rates vary and test capacity may be limited. As PCR-testing all ED patients is neither feasible nor effective in most centres, a rapid, objective, low-cost early warning score to triage ED patients for a possible infection is developed.
Design: Case-control study.
Setting: Secondary and tertiary hospitals in the Netherlands.
Participants: The study included patients presenting to the ED with venous blood sampling from July 2019 to July 2020 (n=10 417, 279 SARS-CoV-2-positive). The temporal validation cohort covered the period from July 2020 to October 2021 (n=14 080, 1093 SARS-CoV-2-positive). The external validation cohort consisted of patients presenting to the ED of three hospitals in the Netherlands (n=12 061, 652 SARS-CoV-2-positive).
Primary Outcome Measures: The primary outcome was one or more positive SARS-CoV-2 PCR test results within 1 day prior to or 1 week after ED presentation.
Results: The resulting 'CoLab-score' consists of 10 routine laboratory measurements and age. The score showed good discriminative ability (AUC: 0.930, 95% CI 0.909 to 0.945). The lowest CoLab-score had high sensitivity for COVID-19 (0.984, 95% CI 0.970 to 0.991; specificity: 0.411, 95% CI 0.285 to 0.520). Conversely, the highest score had high specificity (0.978, 95% CI 0.973 to 0.983; sensitivity: 0.608, 95% CI 0.522 to 0.685). The results were confirmed in temporal and external validation.
Conclusions: The CoLab-score is based on routine laboratory measurements and is available within 1 hour after presentation. Depending on the prevalence, COVID-19 may be safely ruled out in over one-third of ED presentations. Highly suspect cases can be identified regardless of presenting symptoms. The CoLab-score is continuous, in contrast to the binary outcome of lateral flow testing, and can guide PCR testing and triage ED patients.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
| Titel: |
Development and validation of an early warning score to identify COVID-19 in the emergency department based on routine laboratory tests: a multicentre case-control study.
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| Autor/in / Beteiligte Person: | Boer, AK ; Deneer, R ; Maas, M ; Ammerlaan, HSM ; van Balkom RHH ; Thijssen, WAHM ; Bennenbroek, S ; Leers, M ; Martens, RJH ; Buijs, MM ; Kerremans, JJ ; Messchaert, M ; van Suijlen JJ ; van Riel NAW ; Scharnhorst, V |
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| Zeitschrift: | BMJ open, Jg. 12 (2022-08-03), Heft 8, S. e059111 |
| Veröffentlichung: | [London] : BMJ Publishing Group Ltd, 2011-, 2022 |
| Medientyp: | academicJournal |
| ISSN: | 2044-6055 (electronic) |
| DOI: | 10.1136/bmjopen-2021-059111 |
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