Validating the RISE UP score for predicting prognosis in patients with COVID-19 in the emergency department: a retrospective study

  1. Paul MEL van Dam
  2. Noortje Zelis
  3. Patricia Stassen
  4. Daan J L van Twist
  5. Peter W De Leeuw
  6. Sander van Kuijk
  7. Jacqueline Buijs

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Abstract

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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  1. Version published to 10.1136/bmjopen-2020-045141
  2. ScreenIT

    SciScore for 10.1101/2020.11.23.20236786: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: This study was approved by the medical ethics committee of the Zuyderland MC (METCZ20200136).
    Consent: Informed consent was obtained retrospectively by an opt-out method by writing a letter to the included patients.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has several limitations. First, our study was performed in the two EDs of one medical centre which may limit generalizability of the results. However, our study has a relatively large cohort of patients with COVID-19 in one of the most heavily affected areas of the Netherlands. Second, 89 patients (13.9%) did not have a positive PCR result. Because there is no gold standard for the diagnosis of COVID-19 and the diagnostic accuracy of the PCR is limited, we believe it is diligent to also include patients with symptoms suggestive of COVID-19 and a positive result of the chest CT scan. Other studies have used these inclusion criteria as well.[20] If we apply the RISE UP score only to the patients that were confirmed with PCR, we found similar discriminatory values (AUC 0.76 (95% CI: 0.71-0.80) for 30-day mortality). Next, our study was limited to patients admitted to the hospital. It would be interesting to apply the RISE UP score to patients who would be discharged. However, these data were not available to us. Finally, the number of ICU admissions in our study was relatively low (15.9%), which may result from decisions to initiate conservative care in patients with pre-existing frailty or severe comorbidity. These decisions may be different in other countries, which made us decide to study ICU admissions as a composite outcome only. Since existing literature is dominated by predicting mortality in patients with COVID-19, we consider the inclusion of ICU admission a s...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.11.23.20236786v1 on medRxiv