Derivation and validation of a clinical severity score for acutely ill adults with suspected COVID-19: the PRIEST observational cohort study
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Abstract
Objectives: We aimed to derive and validate a triage tool, based on clinical assessment alone, for predicting adverse outcome in acutely ill adults with suspected COVID-19 infection. Methods: We undertook a mixed prospective and retrospective observational cohort study in 70 emergency departments across the United Kingdom (UK). We collected presenting data from 22445 people attending with suspected COVID-19 between 26 March 2020 and 28 May 2020. The primary outcome was death or organ support (respiratory, cardiovascular, or renal) by record review at 30 days. We split the cohort into derivation and validation sets, developed a clinical score based on the coefficients from multivariable analysis using the derivation set, and the estimated discriminant performance using the validation set. Results: We analysed 11773 derivation and 9118 validation cases. Multivariable analysis identified that age, sex, respiratory rate, systolic blood pressure, oxygen saturation/inspired oxygen ratio, performance status, consciousness, history of renal impairment, and respiratory distress were retained in analyses restricted to the ten or fewer predictors. We used findings from multivariable analysis and clinical judgement to develop a score based on the NEWS2 score, age, sex, and performance status. This had a c-statistic of 0.80 (95% confidence interval 0.79–0.81) in the validation cohort and predicted adverse outcome with sensitivity 0.98 (0.97–0.98) and specificity 0.34 (0.34–0.35) for scores above four points. Conclusion: A clinical score based on NEWS2, age, sex, and performance status predicts adverse outcome with good discrimination in adults with suspected COVID-19 and can be used to support decision-making in emergency care. Registration: ISRCTN registry, ISRCTN28342533, http://www.isrctn.com/ISRCTN28342533
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Patients with early DNACPR decisions were at a higher risk of adverse outcome (median PRIEST COVID-19 clinical severity score 12 vs 9, indicating 38% vs 26% expected risk of a 30-day adverse outcome).
“Fig. 3 compares the PRIEST COVID-19 clinical severity scores for the two groups and shows that those with early DNACPR decisions were at a higher risk of adverse outcome (median score 12 versus 9, respectively indicating 38% versus 26% expected risk of a 30-day adverse outcome).17”
From Do not attempt cardiopulmonary resuscitation (DNACPR) decisions in people admitted with suspected COVID-19: Secondary analysis of the PRIEST observational cohort study (2021) · cites this paper as [17]
The Results describe Fig. 4 as showing the probability of a 30-day adverse outcome for each PRIEST score, supporting the use of the score to compare expected risk. Our copy does not state that scores of 12 and 9 correspond to 38% and 26% risk. The early-DNACPR group medians are the citing paper’s own Fig. 3 finding, not a finding attributed to PRIEST. (LLM, conf=0.79)
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- Authors
- Goodacre, S., Thomas, B., Sutton, L., Burnsall, M., Lee, E., Bradburn, M., Loban, A., Waterhouse, S., Simmonds, R., Biggs, K., Marincowitz, C., Schutter, J., Connelly, S., Sheldon, E., Hall, J., Young, E., Bentley, A., Challen, K., Fitzsimmons, C., Harris, T., Lecky, F., Lee, A., Maconochie, I., & Walter, D.
- Affiliations
- University of Sheffield (GB)
- Manchester University NHS Foundation Trust (GB)
- Lancashire Teaching Hospitals NHS Foundation Trust (GB)
- Sheffield Children's NHS Foundation Trust (GB)
- Barts Health NHS Trust (GB)
- Imperial College Healthcare NHS Trust (GB)
- Corresponding author
- Goodacre, Steve
- ORCID
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2021-01-22
- Volume
- 16
- Issue
- 1
- Pages
- e0245840
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC7822515
- OpenAlex
- W3121562086
- Cited by
- 89
- References
- 15
- Citations by year
- 2026: 5 · 2025: 10 · 2024: 17 · 2023: 20 · 2022: 23 · 2021: 13 · 2020: 1
- FWCI
- 5.78
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- medRxiv (acceptedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion, other-oa)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Health Technology Assessment Programme (11/46/07)
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Keywords
- COVID-19 pandemic, clinical severity score, triage tool, emergency department, NEWS2, performance status, mortality prediction, organ support, clinical judgment, risk stratification
- MeSH terms
- COVID-19, SARS-CoV-2, Adult, Aged, Aged, 80 and over, Female, United Kingdom, Humans, Male, Middle Aged, Prognosis, Prospective Studies, Retrospective Studies, Severity of Illness Index, Risk Assessment
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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