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Validating the RISE UP score for predicting prognosis in patients with COVID-19 in the emergency department: a
Paul Mel van Dam1, Noortje Zelis2,3,4, Patricia Stassen2,5
1Department of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands paul.van.dam@mumc.nl.
Insights
The Risk Stratification in the Emergency Department in Acutely ill Older Patients (RISE UP) score accurately predicts 30-day mortality in COVID-19 patients. This tool helps identify high-risk individuals for better healthcare resource allocation.
Area of Science:
- Emergency Medicine
- Infectious Diseases
- Public Health
Background:
- COVID-19 poses a significant burden on healthcare systems, necessitating accurate prognostic tools.
- The Risk Stratification in the Emergency Department in Acutely ill Older Patients (RISE UP) score demonstrates strong predictive value for mortality in older emergency department (ED) patients.
- The utility of the RISE UP score for predicting outcomes in COVID-19 patients requires investigation.
Purpose of the Study:
- To evaluate the discriminatory value of the RISE UP score for 30-day mortality in emergency department (ED) patients diagnosed with COVID-19.
- To assess the RISE UP score's ability to predict a composite outcome of 30-day mortality and intensive care unit (ICU) admission.
Main Methods:
- Retrospective analysis of 642 adult COVID-19 patients admitted to two EDs between March and May 2020.
- Inclusion criteria included symptoms suggestive of COVID-19 with positive PCR or high suspicion based on chest CT scan.
- Primary outcome was 30-day mortality; secondary outcome was a composite of 30-day mortality and ICU admission.
Main Results:
- The RISE UP score demonstrated good discriminatory value for 30-day mortality (AUC 0.77) and the composite outcome (AUC 0.72).
- Among patients with RISE UP scores below 10%, there were no deaths and only six ICU admissions.
- Patients with RISE UP scores above 30% experienced high rates of adverse outcomes, including 46.6% mortality and 19.0% ICU admissions.
Conclusions:
- The RISE UP score is a validated prognostic model for adverse outcomes in COVID-19 patients presenting to the ED.
- This score can effectively identify patients at high risk for short-term adverse events.
- The RISE UP score may aid in clinical decision-making and the strategic allocation of healthcare resources during the pandemic.
Objective:
To mitigate the burden of COVID-19 on the healthcare system, information on the prognosis of the disease is needed. The recently developed Risk Stratification in the Emergency Department in Acutely ill Older Patients (RISE UP) score has very good discriminatory value for short-term mortality in older patients in the emergency department (ED). It consists of six readily available items. We hypothesised that the RISE UP score could have discriminatory value for 30-day mortality in ED patients with COVID-19.
Design:
Retrospective analysis.
Setting:
Two EDs of the Zuyderland Medical Centre, secondary care hospital in the Netherlands.
Participants:
The study sample consisted of 642 adult ED patients diagnosed with COVID-19 between 3 March and until 25 May 2020. Inclusion criteria were (1) admission to the hospital with symptoms suggestive of COVID-19 and (2) positive result of the PCR or (very) high suspicion of COVID-19 according to the chest CT scan.
Outcome:
Primary outcome was 30-day mortality, secondary outcome was a composite of 30-day mortality and admission to intensive care unit (ICU).
Results:
Within 30 days after presentation, 167 patients (26.0%) died and 102 patients (15.9%) were admitted to ICU. The RISE UP score showed good discriminatory value for 30-day mortality (area under the receiver operating characteristic curve (AUC) 0.77, 95% CI 0.73 to 0.81) and for the composite outcome (AUC 0.72, 95% CI 0.68 to 0.76). Patients with RISE UP scores below 10% (n=121) had favourable outcome (zero deaths and six ICU admissions), while those with scores above 30% (n=221) were at high risk of adverse outcome (46.6% mortality and 19.0% ICU admissions).
Conclusion:
The RISE UP score is an accurate prognostic model for adverse outcome in ED patients with COVID-19. It can be used to identify patients at risk of short-term adverse outcome and may help guide decision-making and allocating healthcare resources.
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