Prognostic accuracy of eight triage scores in suspected COVID-19 in an
Emergency Department low-income setting: An observational cohort study
Dublin Core
Title
Prognostic accuracy of eight triage scores in suspected COVID-19 in an
Emergency Department low-income setting: An observational cohort study
Emergency Department low-income setting: An observational cohort study
Subject
Covid-19
Triage
Risk-stratification
Lower- middle- income countries (LMICS) &
Emergency Department
Triage
Risk-stratification
Lower- middle- income countries (LMICS) &
Emergency Department
Description
Introduction: Previous studies deriving and validating triage scores for patients with suspected COVID-19 in
Emergency Department settings have been conducted in high- or middle-income settings. We assessed eight
triage scores’ accuracy for death or organ support in patients with suspected COVID-19 in Sudan.
Methods: We conducted an observational cohort study using Covid-19 registry data from eight emergency unit
isolation centres in Khartoum State, Sudan. We assessed performance of eight triage scores including: PRIEST,
LMIC-PRIEST, NEWS2, TEWS, the WHO algorithm, CRB-65, Quick COVID-19 Severity Index and PMEWS in
suspected COVID-19. A composite primary outcome included death, ventilation or ICU admission.
Results: In total 874 (33.84 %, 95 % CI:32.04 % to 35.69 %) of 2,583 patients died, required intubation/noninvasive ventilation or HDU/ICU admission . All risk-stratification scores assessed had worse estimated
discrimination in this setting, compared to studies conducted in higher-income settings: C-statistic range for
primary outcome: 0.56–0.64. At previously recommended thresholds NEWS2, PRIEST and LMIC-PRIEST had
high estimated sensitivities (≥0.95) for the primary outcome. However, the high baseline risk meant that lowrisk patients identified at these thresholds still had a between 8 % and 17 % risk of death, ventilation or ICU
admission.
Conclusion: None of the triage scores assessed demonstrated sufficient accuracy to be used clinically. This is likely
due to differences in the health care system and population (23 % of patients died) compared to higher-income
settings in which the scores were developed. Risk-stratification scores developed in this setting are needed to
provide the necessary accuracy to aid triage of patients with suspected COVID-19.
Emergency Department settings have been conducted in high- or middle-income settings. We assessed eight
triage scores’ accuracy for death or organ support in patients with suspected COVID-19 in Sudan.
Methods: We conducted an observational cohort study using Covid-19 registry data from eight emergency unit
isolation centres in Khartoum State, Sudan. We assessed performance of eight triage scores including: PRIEST,
LMIC-PRIEST, NEWS2, TEWS, the WHO algorithm, CRB-65, Quick COVID-19 Severity Index and PMEWS in
suspected COVID-19. A composite primary outcome included death, ventilation or ICU admission.
Results: In total 874 (33.84 %, 95 % CI:32.04 % to 35.69 %) of 2,583 patients died, required intubation/noninvasive ventilation or HDU/ICU admission . All risk-stratification scores assessed had worse estimated
discrimination in this setting, compared to studies conducted in higher-income settings: C-statistic range for
primary outcome: 0.56–0.64. At previously recommended thresholds NEWS2, PRIEST and LMIC-PRIEST had
high estimated sensitivities (≥0.95) for the primary outcome. However, the high baseline risk meant that lowrisk patients identified at these thresholds still had a between 8 % and 17 % risk of death, ventilation or ICU
admission.
Conclusion: None of the triage scores assessed demonstrated sufficient accuracy to be used clinically. This is likely
due to differences in the health care system and population (23 % of patients died) compared to higher-income
settings in which the scores were developed. Risk-stratification scores developed in this setting are needed to
provide the necessary accuracy to aid triage of patients with suspected COVID-19.
Creator
Carl Marincowitz a,*
, Madina Hasan a
, Yasein Omer b
, Peter Hodkinson b
, David McAlpine b
,
Steve Goodacre a
, Peter A. Bath a,c
, Gordon Fuller a
, Laura Sbaffi c
, Lee Wallis b
, Madina Hasan a
, Yasein Omer b
, Peter Hodkinson b
, David McAlpine b
,
Steve Goodacre a
, Peter A. Bath a,c
, Gordon Fuller a
, Laura Sbaffi c
, Lee Wallis b
Source
https://pdf.sciencedirectassets.com/280685/1-s2.0-S2211419X23X00056/1-s2.0-S2211419X2300068X/main.pdf?X-Amz-Security-Token=IQoJb3JpZ2luX2VjEKD%2F%2F%2F%2F%2F%2F%2F%2F%2F%2FwEaCXVzLWVhc3QtMSJHMEUCIBmxCvwHnnqfyBWpgaN69ISpiEAla2u7ezHb4T8SA610AiEA%2B9Ydh8QwmUOlSupw5%2B6sZBuEuBEdqyRvJRXNGsMy0IkqvAUIif%2F%2F%2F%2F%2F%2F%2F%2F%2F%2FARAFGgwwNTkwMDM1NDY4NjUiDMRL5jlkM2eXePTZuiqQBZYGt9J8EXVD4qFtr6oR7Mi%2FVQd13O6mSqTCDN%2FslytiTW2aZkXsYBPDEVQKBIQru1EP7jbqecpX%2BdzJRyBUCaMmGzUdzmRHVAc%2BErMy2J1BTNHlHM8NwQo%2Bgl2bVHtADvE5tAW37Ncgp1tlpfSHQtvhBjfQ6bJG6JFuy6%2F1gFv0gK8%2B0nlUJRGlp%2Fhk6KVu7nLjTxTF7jwuijw1pCy2jc9TRJkDNlqu%2F4wrio5yP2t%2Bq5eHgsLE9Xh7jH%2BdCjmFXsk3HadPdzulA5pYkcgowJSHBRESz4AJdusHbHOXiAZVwhERjdXV%2BdY7UAbSNBUYwW%2FwdNZSg4ZHVBMtCnZC3wiMA5CWJq9QEEKbdWD%2FmrtQ9tE4eFXlQBkIObJrAV8mpuFZdYKeqG%2BE9oHardVEJobuwNo2uwKd5Q1uVHvskeORJgqwtu%2Fs6NX4cxaGy9fzrQLbsP2N8JFFLnT5h6FV3UKi6B6qVI%2BSy7g%2Bas2WJU2bZPjb0bkf7HnGmgTxb86X460aZ57Ktwkvu5g60n5KAmTmI%2Fpwm8S72w1kkzPyobVYD4v960x6%2F47aj5QNu6oA%2BYSnsJKE%2BGqcrTS01CwJzSGvWh%2Baj9bAtLtQAJR7eiHdtf9lYLnpEv1UueuBztzkVFrPc8efJSvPhg7rp%2BfIUBa6Ld0xK%2BjwxQZ%2Bn8cewS09bXjmf22ImB9uzW%2BuGnvhWsUkIjeQIuC70JP8cMbmA13xBrae9JVaqmRjU%2BzXLb7%2FxUvhP9%2F9toarCnr8cjVQjDdUSWfbu6SvIIvpajd97jVK9Bx1Mdgnqjjmmgn0mRAW74fhmZnaRgm0t7Kn0x5Zaxdy7LuVmmS5MY0SYhsxikHK84UFTwzeubdYhJYJpP5cMPnYycIGOrEBpBRR4hBASlUswsG1oes8OqeMiwWruAZh73U%2BGxFhsi2xVBlTmtGbG%2Fb7XoJ2HpmF0GVOKO%2Far5hMYJ6j%2BzvPoO0hjd4nfUJm3hwqbSaYsyxP%2BeOaSMdkGUn4ug2ZUZkXIIfbV6HM4n%2BRWIXJhpsftUv9lquGyWwTqA2MQtUu0gReEcdaTUIE6T3CTsqIBrkeNfoqec90qo%2FFOE4YTzBHBb%2FDcqGo5PlpjXCKy6ZTZKe7&X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Date=20250618T082637Z&X-Amz-SignedHeaders=host&X-Amz-Expires=300&X-Amz-Credential=ASIAQ3PHCVTYQE6VIBRK%2F20250618%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Signature=59df99d8800d8796c345850c316da24a52102aa8080de50168dda12aae744d7f&hash=31479169a36353aa4508099702a61751b19ae9d65f47e87088275cfc8abf3538&host=68042c943591013ac2b2430a89b270f6af2c76d8dfd086a07176afe7c76c2c61&pii=S2211419X2300068X&tid=spdf-dbe74bf2-8138-4c95-8de2-6e8a804456b5&sid=14b8a1eb7498d34787591540b87a02ee8336gxrqb&type=client&tsoh=d3d3LnNjaWVuY2VkaXJlY3QuY29t&rh=d3d3LnNjaWVuY2VkaXJlY3QuY29t&ua=13025d5355595153530107&rr=9519671adb57ea8a&cc=id
Publisher
a Centre for Urgent and Emergency Care Research (CURE), Population Health, School of Medicine and Population Health, University of Sheffield, Regent Court, 30
Regent Street, Sheffield S1 4DA, UK b Division of Emergency Medicine, Groote Schuur Hospital, University of Cape Town, F51 Old Main Building, Observatory, Cape Town, South Africa c Information School, University of Sheffield, Regent Court, 211 Portobello St, Sheffield S1 4DP, UK
Regent Street, Sheffield S1 4DA, UK b Division of Emergency Medicine, Groote Schuur Hospital, University of Cape Town, F51 Old Main Building, Observatory, Cape Town, South Africa c Information School, University of Sheffield, Regent Court, 211 Portobello St, Sheffield S1 4DP, UK
Date
24 desember 2023
Contributor
Fajar bagus W
Format
PDF
Language
English
Type
Text
Files
Citation
Carl Marincowitz a,*
, Madina Hasan a
, Yasein Omer b
, Peter Hodkinson b
, David McAlpine b
,
Steve Goodacre a
, Peter A. Bath a,c
, Gordon Fuller a
, Laura Sbaffi c
, Lee Wallis b , “Prognostic accuracy of eight triage scores in suspected COVID-19 in an
Emergency Department low-income setting: An observational cohort study,” Repository Horizon University Indonesia, accessed June 20, 2025, https://repository.horizon.ac.id/items/show/9554.
Emergency Department low-income setting: An observational cohort study,” Repository Horizon University Indonesia, accessed June 20, 2025, https://repository.horizon.ac.id/items/show/9554.