Comparison of Six Scoring Systems for Predicting In-hospital Mortality among Patients with SARS-COV2 Presenting to the Emergency Department

Authors

Zahra Rahmatinejad, Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Benyamin Hoseini, Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
Hamidreza Reihani, Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Ameen Abu Hanna, Department of Medical Informatics, Amsterdam UMC - Location AMC, University of Amsterdam, the Netherlands.
Ali Pourmand, Department of Emergency Medicine, The George Washington University, School of Medicine and Health Sciences, Washington DC, United States.
Seyyed Mohammad Tabatabaei, Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Fatemeh Rahmatinejad, Department of Health Information Technology, Faculty of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.
Saeid Eslami, Department of Medical Informatics, Faculty of Medicine; Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Medical Informatics, Amsterdam UMC - Location AMC, University of Amsterdam, the Netherlands.

Document Type

Journal Article

Publication Date

6-1-2023

Journal

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine

Volume

27

Issue

6

DOI

10.5005/jp-journals-10071-24463

Keywords

COVID-19; Emergency department; Mortality prediction; Performance measures; Scoring system

Abstract

BACKGROUND: The study aimed to compare the prognostic accuracy of six different severity-of-illness scoring systems for predicting in-hospital mortality among patients with confirmed SARS-COV2 who presented to the emergency department (ED). The scoring systems assessed were worthing physiological score (WPS), early warning score (EWS), rapid acute physiology score (RAPS), rapid emergency medicine score (REMS), national early warning score (NEWS), and quick sequential organ failure assessment (qSOFA). MATERIALS AND METHODS: A cohort study was conducted using data obtained from electronic medical records of 6,429 confirmed SARS-COV2 patients presenting to the ED. Logistic regression models were fitted on the original severity-of-illness scores to assess the models' performance using the Area Under the Curve for ROC (AUC-ROC) and Precision-Recall curves (AUC-PR), Brier Score (BS), and calibration plots were used to assess the models' performance. Bootstrap samples with multiple imputations were used for internal validation. RESULTS: The mean age of the patients was 64 years (IQR:50-76) and 57.5% were male. The WPS, REMS, and NEWS models had AUROC of 0.714, 0.705, and 0.701, respectively. The poorest performance was observed in the RAPS model, with an AUROC of 0.601. The BS for the NEWS, qSOFA, EWS, WPS, RAPS, and REMS was 0.18, 0.09, 0.03, 0.14, 0.15, and 0.11 respectively. Excellent calibration was obtained for the NEWS, while the other models had proper calibration. CONCLUSION: The WPS, REMS, and NEWS have a fair discriminatory performance and may assist in risk stratification for SARS-COV2 patients presenting to the ED. Generally, underlying diseases and most vital signs are positively associated with mortality and were different between the survivors and non-survivors. HOW TO CITE THIS ARTICLE: Rahmatinejad Z, Hoseini B, Reihani H, Hanna AA, Pourmand A, Tabatabaei SM, . Comparison of Six Scoring Systems for Predicting In-hospital Mortality among Patients with SARS-COV2 Presenting to the Emergency Department. Indian J Crit Care Med 2023;27(6):416-425.

APA Citation

Rahmatinejad, Zahra; Hoseini, Benyamin; Reihani, Hamidreza; Hanna, Ameen Abu; Pourmand, Ali; Tabatabaei, Seyyed Mohammad; Rahmatinejad, Fatemeh; and Eslami, Saeid, "Comparison of Six Scoring Systems for Predicting In-hospital Mortality among Patients with SARS-COV2 Presenting to the Emergency Department" (2023). GW Authored Works. Paper 2770.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2770

Department

Emergency Medicine