Cited by 89COVID-19 Clinical Research StudiesSepsis Diagnosis and TreatmentEmergency and Acute Care Studies

Derivation and validation of a clinical severity score for acutely ill adults with suspected COVID-19: the PRIEST observational cohort study

Open access
Goodacre, Steve, Thomas, Ben, Sutton, Laura, Burnsall, Matthew, Lee, Ellen, Bradburn, Mike, Loban, Amanda, Waterhouse, Simon +16 more·2021·PLOS ONE

Published version of a preprint

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

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1371/journal.pone.0245840

Cites

14 of 14 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • 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)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

1 of the 15 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. [4]National Institute for Health and Care Excellence. COVID-19 rapid guideline: managing suspected or confirmed pneumonia in adults in the community. Published: 3 April 2020. www.nice.org.uk/guidance/ng165 (accessed 28/04/2020) 33497157

Cited by

Sorted by citations

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
Venue
PLOS ONE
Published
2021-01-22
Volume
16
Issue
1
Pages
e0245840
ISSN
1932-6203 (ISSN-L)
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
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.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review