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.

Autor:	Boer AK; Department of Laboratory Medicine, Catharina Hospital, Eindhoven, The Netherlands., Deneer R; Department of Laboratory Medicine, Catharina Hospital, Eindhoven, The Netherlands ruben.deneer@catharinaziekenhuis.nl.; Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands., Maas M; Department of Emergency Medicine, Catharina Hospital, Eindhoven, The Netherlands., Ammerlaan HSM; Department of Internal Medicine, Catharina Hospital, Eindhoven, The Netherlands., van Balkom RHH; Department of Pulmonary Diseases, Catharina Hospital, Eindhoven, The Netherlands., Thijssen WAHM; Department of Emergency Medicine, Catharina Ziekenhuis, Eindhoven, The Netherlands., Bennenbroek S; Department of Emergency Medicine, Catharina Ziekenhuis, Eindhoven, The Netherlands., Leers M; Department of Clinical Chemistry and Hematology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands., Martens RJH; Department of Clinical Chemistry and Hematology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands., Buijs MM; Atalmedial Diagnostic Centers, Amsterdam, The Netherlands., Kerremans JJ; Department of Medical Microbiology and Infection Prevention, Alrijne Hospital, Leiderdorp, The Netherlands., Messchaert M; Department of Clinical Chemistry, Gelre Hospitals, Apeldoorn, The Netherlands., van Suijlen JJ; Department of Clinical Chemistry, Gelre Hospitals, Apeldoorn, The Netherlands., van Riel NAW; Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.; Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands., Scharnhorst V; Department of Laboratory Medicine, Catharina Hospital, Eindhoven, The Netherlands.; Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2022 Aug 03; Vol. 12 (8), pp. e059111. Date of Electronic Publication: 2022 Aug 03.
DOI:	10.1136/bmjopen-2021-059111
Abstrakt:	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.)
Databáze:	MEDLINE
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