key: cord-0857395-oxckqaop
authors: Meylan, Sylvain; Akrour, Rachid; Regina, Jean; Bart, Pierre-Alexandre; Dami, Fabrice; Calandra, Thierry
title: An Early Warning Score to predict ICU admission in COVID-19 positive patients
date: 2020-05-28
journal: J Infect
DOI: 10.1016/j.jinf.2020.05.047
sha: 45bbba32e3e6ebd7b5399b7509a7f4cd2d556d46
doc_id: 857395
cord_uid: oxckqaop

nan

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) poses multiple challenges to our healthcare systems. A particular challenge is the surge of hospital admissions with a significant fraction requiring transfer to intensive care units (ICU) because of respiratory failure. 1 Mean duration of symptoms prior to t0 was 7.8 days in the ICU-group and 7.6 days in the ICU group. Risk factors 2 associated with severe COVID were present in 80.8% of the patients (ICU group: 77.7% and non-ICU group: 82.3%). Figure 1 shows the evolution of the EWS over a study period up to 36 hours prior t0 in the two groups of patients.

The median EWS was significantly higher in a time-dependent manner in ICU group than in the non-ICU group (p<0.0001) as assessed by mixed effects model 5 . At time zero or -12 hours, a EWS greater than 7 predicted ICU admission with sensitivities and specificities of 87% and 93% and 94% and 78%, respectively (AUROC 0.98 and 0.88, respectively).

These data suggest that EWS may help clinicians identify COVID-19 patients who will require ICU admission. The low number of patients considered and its retrospective and single-center setting limits this study. Still, in time of patient surge, this simple tool may prove useful for initial triage in the emergency department and subsequent monitoring of patients upon admission to hospital wards.

Declarations:

-The CER-VD (ref. nbr. 2020-00776) waived consent to participate and consent for publication for this research according to ORH art. 34 (Switzerland).

-No funding was required for this work. 

Critical Care Utilization for the COVID-19 Outbreak in

Clinical Characteristics of Coronavirus Disease 2019 in China

Comparison of CRB-65 and quick sepsis-related organ failure assessment for predicting the need for intensive respiratory or vasopressor support in patients with COVID-19

ViEWS-Towards a national early warning score for detecting adult inpatient deterioration

A Unified Approach to Mixed Linear Models

Time zero refers to the time at which the last set of physiological variables was recorded prior to ICU admission (ICU group, red) or to the worst respiratory variables (non-ICU group, blue)

We wish to thank Raphael Burger of the Internal Medicine Department of Lausanne University Hospital, Isabelle Guilleret and Fady Fares at the Clinical Trial Unit of Lausanne University Hospital as well as Patrick Francioli.