Development and validation of an early warning score to identify COVID-19 in the emergency department based on routine laboratory tests: a multicentre case-control study

Arjen-Kars Boer; Ruben Deneer; Maaike Maas; Heidi S.M. Ammerlaan; Roland H.H. van Balkom; Wendy A.H.M. Thijssen; Sophie Bennenbroek; Mathie Leers; Remy J.H. Martens; Madelon M Buijs; Jos J. Kerremans; Muriël Messchaert; Jeroen J van Suijlen; Natal A.W. van Riel; Volkher Scharnhorst

doi:10.1136/bmjopen-2021-059111

Development and validation of an early warning score to identify COVID-19 in the emergency department based on routine laboratory tests: a multicentre case-control study

Arjen-Kars Boer, Ruben Deneer (Corresponding author), Maaike Maas, Heidi S.M. Ammerlaan, Roland H.H. van Balkom, Wendy A.H.M. Thijssen, Sophie Bennenbroek, Mathie Leers, Remy J.H. Martens, Madelon M Buijs, Jos J. Kerremans, Muriël Messchaert, Jeroen J van Suijlen, Natal A.W. van Riel, Volkher Scharnhorst

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

OBJECTIVES: Identifying patients with a possible SARS-CoV-2 infection in the emergency department (ED) is challenging. Symptoms differ, incidence rates vary and test capacity may be limited. As PCR-testing all ED patients is neither feasible nor effective in most centres, a rapid, objective, low-cost early warning score to triage ED patients for a possible infection is developed.

DESIGN: Case-control study.

SETTING: Secondary and tertiary hospitals in the Netherlands.

PARTICIPANTS: The study included patients presenting to the ED with venous blood sampling from July 2019 to July 2020 (n=10 417, 279 SARS-CoV-2-positive). The temporal validation cohort covered the period from July 2020 to October 2021 (n=14 080, 1093 SARS-CoV-2-positive). The external validation cohort consisted of patients presenting to the ED of three hospitals in the Netherlands (n=12 061, 652 SARS-CoV-2-positive).

PRIMARY OUTCOME MEASURES: The primary outcome was one or more positive SARS-CoV-2 PCR test results within 1 day prior to or 1 week after ED presentation.

RESULTS: The resulting 'CoLab-score' consists of 10 routine laboratory measurements and age. The score showed good discriminative ability (AUC: 0.930, 95% CI 0.909 to 0.945). The lowest CoLab-score had high sensitivity for COVID-19 (0.984, 95% CI 0.970 to 0.991; specificity: 0.411, 95% CI 0.285 to 0.520). Conversely, the highest score had high specificity (0.978, 95% CI 0.973 to 0.983; sensitivity: 0.608, 95% CI 0.522 to 0.685). The results were confirmed in temporal and external validation.

CONCLUSIONS: The CoLab-score is based on routine laboratory measurements and is available within 1 hour after presentation. Depending on the prevalence, COVID-19 may be safely ruled out in over one-third of ED presentations. Highly suspect cases can be identified regardless of presenting symptoms. The CoLab-score is continuous, in contrast to the binary outcome of lateral flow testing, and can guide PCR testing and triage ED patients.

Original language	English
Article number	e059111
Number of pages	12
Journal	BMJ open
Volume	12
Issue number	8
DOIs	https://doi.org/10.1136/bmjopen-2021-059111
Publication status	Published - 3 Aug 2022

Keywords

COVID-19/diagnosis
Case-Control Studies
Early Warning Score
Emergency Service, Hospital
Humans
SARS-CoV-2
Tertiary Care Centers
COVID-19
Clinical chemistry
accident & emergency medicine
statistics & research methods
Health informatics

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10.1136/bmjopen-2021-059111

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Boer, A.-K., Deneer, R., Maas, M., Ammerlaan, H. S. M., van Balkom, R. H. H., Thijssen, W. A. H. M., Bennenbroek, S., Leers, M., Martens, R. J. H., Buijs, M. M., Kerremans, J. J., Messchaert, M., van Suijlen, J. J., van Riel, N. A. W., & Scharnhorst, V. (2022). Development and validation of an early warning score to identify COVID-19 in the emergency department based on routine laboratory tests: a multicentre case-control study. BMJ open, 12(8), Article e059111. https://doi.org/10.1136/bmjopen-2021-059111

@article{1d6339668fee41139c46452c981ed14a,

title = "Development and validation of an early warning score to identify COVID-19 in the emergency department based on routine laboratory tests: a multicentre case-control study",

abstract = "OBJECTIVES: Identifying patients with a possible SARS-CoV-2 infection in the emergency department (ED) is challenging. Symptoms differ, incidence rates vary and test capacity may be limited. As PCR-testing all ED patients is neither feasible nor effective in most centres, a rapid, objective, low-cost early warning score to triage ED patients for a possible infection is developed.DESIGN: Case-control study.SETTING: Secondary and tertiary hospitals in the Netherlands.PARTICIPANTS: The study included patients presenting to the ED with venous blood sampling from July 2019 to July 2020 (n=10 417, 279 SARS-CoV-2-positive). The temporal validation cohort covered the period from July 2020 to October 2021 (n=14 080, 1093 SARS-CoV-2-positive). The external validation cohort consisted of patients presenting to the ED of three hospitals in the Netherlands (n=12 061, 652 SARS-CoV-2-positive).PRIMARY OUTCOME MEASURES: The primary outcome was one or more positive SARS-CoV-2 PCR test results within 1 day prior to or 1 week after ED presentation.RESULTS: The resulting 'CoLab-score' consists of 10 routine laboratory measurements and age. The score showed good discriminative ability (AUC: 0.930, 95% CI 0.909 to 0.945). The lowest CoLab-score had high sensitivity for COVID-19 (0.984, 95% CI 0.970 to 0.991; specificity: 0.411, 95% CI 0.285 to 0.520). Conversely, the highest score had high specificity (0.978, 95% CI 0.973 to 0.983; sensitivity: 0.608, 95% CI 0.522 to 0.685). The results were confirmed in temporal and external validation.CONCLUSIONS: The CoLab-score is based on routine laboratory measurements and is available within 1 hour after presentation. Depending on the prevalence, COVID-19 may be safely ruled out in over one-third of ED presentations. Highly suspect cases can be identified regardless of presenting symptoms. The CoLab-score is continuous, in contrast to the binary outcome of lateral flow testing, and can guide PCR testing and triage ED patients.",

keywords = "COVID-19/diagnosis, Case-Control Studies, Early Warning Score, Emergency Service, Hospital, Humans, SARS-CoV-2, Tertiary Care Centers, COVID-19, Clinical chemistry, accident & emergency medicine, statistics & research methods, Health informatics",

author = "Arjen-Kars Boer and Ruben Deneer and Maaike Maas and Ammerlaan, {Heidi S.M.} and {van Balkom}, {Roland H.H.} and Thijssen, {Wendy A.H.M.} and Sophie Bennenbroek and Mathie Leers and Martens, {Remy J.H.} and Buijs, {Madelon M} and Kerremans, {Jos J.} and Muri{\"e}l Messchaert and {van Suijlen}, {Jeroen J} and {van Riel}, {Natal A.W.} and Volkher Scharnhorst",

note = "{\textcopyright} Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2022",

month = aug,

day = "3",

doi = "10.1136/bmjopen-2021-059111",

language = "English",

volume = "12",

journal = "BMJ open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "8",

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Boer, A-K , Deneer, R, Maas, M, Ammerlaan, HSM, van Balkom, RHH, Thijssen, WAHM, Bennenbroek, S, Leers, M, Martens, RJH, Buijs, MM, Kerremans, JJ, Messchaert, M, van Suijlen, JJ, van Riel, NAW & Scharnhorst, V 2022, 'Development and validation of an early warning score to identify COVID-19 in the emergency department based on routine laboratory tests: a multicentre case-control study', BMJ open, vol. 12, no. 8, e059111. https://doi.org/10.1136/bmjopen-2021-059111

Development and validation of an early warning score to identify COVID-19 in the emergency department based on routine laboratory tests: a multicentre case-control study. / Boer, Arjen-Kars ; Deneer, Ruben (Corresponding author); Maas, Maaike et al.
In: BMJ open, Vol. 12, No. 8, e059111, 03.08.2022.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Development and validation of an early warning score to identify COVID-19 in the emergency department based on routine laboratory tests

T2 - a multicentre case-control study

AU - Boer, Arjen-Kars

AU - Deneer, Ruben

AU - Maas, Maaike

AU - Ammerlaan, Heidi S.M.

AU - van Balkom, Roland H.H.

AU - Thijssen, Wendy A.H.M.

AU - Bennenbroek, Sophie

AU - Leers, Mathie

AU - Martens, Remy J.H.

AU - Buijs, Madelon M

AU - Kerremans, Jos J.

AU - Messchaert, Muriël

AU - van Suijlen, Jeroen J

AU - van Riel, Natal A.W.

AU - Scharnhorst, Volkher

N1 - © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2022/8/3

Y1 - 2022/8/3

N2 - OBJECTIVES: Identifying patients with a possible SARS-CoV-2 infection in the emergency department (ED) is challenging. Symptoms differ, incidence rates vary and test capacity may be limited. As PCR-testing all ED patients is neither feasible nor effective in most centres, a rapid, objective, low-cost early warning score to triage ED patients for a possible infection is developed.DESIGN: Case-control study.SETTING: Secondary and tertiary hospitals in the Netherlands.PARTICIPANTS: The study included patients presenting to the ED with venous blood sampling from July 2019 to July 2020 (n=10 417, 279 SARS-CoV-2-positive). The temporal validation cohort covered the period from July 2020 to October 2021 (n=14 080, 1093 SARS-CoV-2-positive). The external validation cohort consisted of patients presenting to the ED of three hospitals in the Netherlands (n=12 061, 652 SARS-CoV-2-positive).PRIMARY OUTCOME MEASURES: The primary outcome was one or more positive SARS-CoV-2 PCR test results within 1 day prior to or 1 week after ED presentation.RESULTS: The resulting 'CoLab-score' consists of 10 routine laboratory measurements and age. The score showed good discriminative ability (AUC: 0.930, 95% CI 0.909 to 0.945). The lowest CoLab-score had high sensitivity for COVID-19 (0.984, 95% CI 0.970 to 0.991; specificity: 0.411, 95% CI 0.285 to 0.520). Conversely, the highest score had high specificity (0.978, 95% CI 0.973 to 0.983; sensitivity: 0.608, 95% CI 0.522 to 0.685). The results were confirmed in temporal and external validation.CONCLUSIONS: The CoLab-score is based on routine laboratory measurements and is available within 1 hour after presentation. Depending on the prevalence, COVID-19 may be safely ruled out in over one-third of ED presentations. Highly suspect cases can be identified regardless of presenting symptoms. The CoLab-score is continuous, in contrast to the binary outcome of lateral flow testing, and can guide PCR testing and triage ED patients.

AB - OBJECTIVES: Identifying patients with a possible SARS-CoV-2 infection in the emergency department (ED) is challenging. Symptoms differ, incidence rates vary and test capacity may be limited. As PCR-testing all ED patients is neither feasible nor effective in most centres, a rapid, objective, low-cost early warning score to triage ED patients for a possible infection is developed.DESIGN: Case-control study.SETTING: Secondary and tertiary hospitals in the Netherlands.PARTICIPANTS: The study included patients presenting to the ED with venous blood sampling from July 2019 to July 2020 (n=10 417, 279 SARS-CoV-2-positive). The temporal validation cohort covered the period from July 2020 to October 2021 (n=14 080, 1093 SARS-CoV-2-positive). The external validation cohort consisted of patients presenting to the ED of three hospitals in the Netherlands (n=12 061, 652 SARS-CoV-2-positive).PRIMARY OUTCOME MEASURES: The primary outcome was one or more positive SARS-CoV-2 PCR test results within 1 day prior to or 1 week after ED presentation.RESULTS: The resulting 'CoLab-score' consists of 10 routine laboratory measurements and age. The score showed good discriminative ability (AUC: 0.930, 95% CI 0.909 to 0.945). The lowest CoLab-score had high sensitivity for COVID-19 (0.984, 95% CI 0.970 to 0.991; specificity: 0.411, 95% CI 0.285 to 0.520). Conversely, the highest score had high specificity (0.978, 95% CI 0.973 to 0.983; sensitivity: 0.608, 95% CI 0.522 to 0.685). The results were confirmed in temporal and external validation.CONCLUSIONS: The CoLab-score is based on routine laboratory measurements and is available within 1 hour after presentation. Depending on the prevalence, COVID-19 may be safely ruled out in over one-third of ED presentations. Highly suspect cases can be identified regardless of presenting symptoms. The CoLab-score is continuous, in contrast to the binary outcome of lateral flow testing, and can guide PCR testing and triage ED patients.

KW - COVID-19/diagnosis

KW - Case-Control Studies

KW - Early Warning Score

KW - Emergency Service, Hospital

KW - Humans

KW - SARS-CoV-2

KW - Tertiary Care Centers

KW - COVID-19

KW - Clinical chemistry

KW - accident & emergency medicine

KW - statistics & research methods

KW - Health informatics

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U2 - 10.1136/bmjopen-2021-059111

DO - 10.1136/bmjopen-2021-059111

M3 - Article

C2 - 35922102

SN - 2044-6055

VL - 12

JO - BMJ open

JF - BMJ open

IS - 8

M1 - e059111

ER -

Development and validation of an early warning score to identify COVID-19 in the emergency department based on routine laboratory tests: a multicentre case-control study

Abstract

Keywords

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Cardiovascular Medicine

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Development and validation of an early warning score to identify COVID-19 in the emergency department based on routine laboratory tests: a multicentre case-control study

Abstract

Keywords

Access to Document

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Research areas

Cardiovascular Medicine

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