Early detection of hospitalized patients with COVID-19 at high risk of clinical deterioration: Utility of emergency department shock index
| Autor: | Jannet D.J. Mehagnoul-Schipper, Inge H.T. van Rensen, Vivian E.M. van Kampen-van den Boogaart, Caroline E. Wyers, Kirsten R.C. Hensgens, Frits H.M. van Osch, Dennis G. Barten, Lieve H.H. Knarren, Joop P. W. van den Bergh, Anita W. Lekx |
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| Přispěvatelé: | Epidemiologie, Complexe Genetica, RS: NUTRIM - R3 - Respiratory & Age-related Health, Interne Geneeskunde |
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male PREDICTOR medicine.medical_specialty Organ Dysfunction Scores Shock index SARS-COV-2 Risk Assessment Article Sepsis Young Adult 03 medical and health sciences 0302 clinical medicine Heart rate medicine Humans Hospital Mortality Myocardial infarction Aged Netherlands Retrospective Studies Aged 80 and over Clinical Deterioration Emergency department business.industry COVID-19 Shock 030208 emergency & critical care medicine General Medicine Middle Aged medicine.disease Triage Intensive Care Units Blood pressure ROC Curve Emergency medicine Cohort Emergency Medicine Female Observational study Emergency Service Hospital business |
| Zdroj: | American Journal of Emergency Medicine, 49, 76-79. W.B. Saunders Ltd The American Journal of Emergency Medicine |
| ISSN: | 0735-6757 |
| DOI: | 10.1016/j.ajem.2021.05.049 |
| Popis: | Background: The COVID-19 outbreak has put an unprecedented strain on Emergency Departments (EDs) and other critical care resources. Early detection of patients that are at high risk of clinical deterioration and require intensive monitoring, is key in ED evaluation and disposition. A rapid and easy risk-stratification tool could aid clinicians in early decision making. The Shock Index (SI: heart rate/systolic blood pressure) proved useful in detecting hemodynamic instability in sepsis and myocardial infarction patients. In this study we aim to determine whether SI is discriminative for ICU admission and in-hospital mortality in COVID-19 patients.Methods: Retrospective, observational, single-center study. All patients >= 18 years old who were hospitalized with COVID-19 (defined as: positive result on reverse transcription polymerase chain reaction (PCR) test) between March 1, 2020 and December 31, 2020 were included for analysis. Data were collected from electronic medical patient records and stored in a protected database. ED shock index was calculated and analyzed for its discriminative value on in-hospital mortality and ICU admission by a ROC curve analysis.Results: In total, 411 patients were included. Of all patients 249 (61%) were male. ICU admission was observed in 92 patients (22%). Of these, 37 patients (40%) died in the ICU. Total in-hospital mortality was 28% (114 patients). For in-hospital mortality the optimal cut-off SI >= 0.86 was not discriminative (AUC 0.49 (95% CI: 0.43-0.56)), with a sensitivity of 12.3% and specificity of 93.6%. For ICU admission the optimal cut-off SI >= 0.57 was also not discriminative (AUC 0.56 (95% CI: 0.49-0.62)), with a sensitivity of 78.3% and a specificity of 34.2%.Conclusion: In this cohort of patients hospitalized with COVID-19, SI measured at ED presentation was not discriminative for ICU admission and was not useful for early identification of patients at risk of clinical deterioration. (C) 2021 Elsevier Inc. All rights reserved. |
| Databáze: | OpenAIRE |
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