Developing useful early warning and prognostic scores for COVID-19
File(s)
Accepted version
Author(s)
Coughlan, Charles
Rahman, Shati
Honeyford, Kate
Costelloe, Ceire
Type
Journal Article
Abstract
Abstract Early recognition of high-risk or deteriorating patients with COVID-19 allows timely treatment escalation and optimises allocation of scarce resources across overstretched healthcare systems. Since the late 1990s, physiological scoring systems have been used in hospital settings to provide an objective signal of clinical deterioration prompting urgent clinical review. Several early warning scores (EWS) accurately predict the need for intensive care unit admission and survival in hospitalised patients with sepsis and other acute illnesses, and their routine use is now recommended in secondary care settings in high and low income countries alike. However, there are widespread concerns that existing EWS, which place a premium on the cardiovascular instability seen in severe sepsis, may fail to identify the deteriorating COVID-19 patient. Dozens of research groups have now assessed the predictive value of existing EWS in hospitalised adults with COVID-19, and used sophisticated statistical methods to develop novel early warning and prognostic scores incorporating vital signs, laboratory tests and imaging results. However, many of these novel scores are at high risk of bias and few have been adopted in routine clinical practice.
In this education and learning article, we will discuss key pitfalls of existing prognostic and EWS in hospitalised adults with COVID-19; outline promising novel scores for this patient group; and describe the ideal properties of scoring systems suitable for use in low and middle income settings.
In this education and learning article, we will discuss key pitfalls of existing prognostic and EWS in hospitalised adults with COVID-19; outline promising novel scores for this patient group; and describe the ideal properties of scoring systems suitable for use in low and middle income settings.
Date Issued
2021-07-23
Date Acceptance
2021-03-25
Citation
Postgraduate Medical Journal, 2021, 97 (1150), pp.477-480
ISSN
0032-5473
Publisher
BMJ Publishing Group
Start Page
477
End Page
480
Journal / Book Title
Postgraduate Medical Journal
Volume
97
Issue
1150
Copyright Statement
© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ. This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.
Sponsor
National Institute for Health Research
Imperial College Healthcare NHS Trust- BRC Funding
National Institute of Health and Medical Research
Grant Number
CDF-2016-09-015
RDA02
NIHR200180
Subjects
adult intensive & critical care
covid-19
education & training (see medical education & training)
respiratory infections
statistics & research methods
11 Medical and Health Sciences
General & Internal Medicine
Publication Status
Published
Date Publish Online
2021-05-28