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J Korean Soc Emerg Med > Volume 34(1); 2023 > Article
Journal of The Korean Society of Emergency Medicine 2023;34(1): 70-78.
코로나바이러스감염증-19 환자에서의 예후 평가에 있어 조기경고점수와 ROX index, CURB-65의 유용성
고진철 , 김지선 , 표창해 , 박현경 , 박근홍 , 김한범 , 함은미 , 박진형 , 송은곤 , 강샛별 , 곽문환 , 최동선 , 김지현
서울의료원 응급의학과
Usefulness of Early Warning Scores, ROX index, and CURB-65 in the prognostic evaluation of patients with COVID-19
Jincheol Ko , Jisun Kim , Chang Hae Pyo , Hyun Kyung Park , Keun Hong Park , Hahn Bom Kim , Eun Mi Ham , Jin Hyung Park , Eungon Song , Saee Byel Kang , Moon Hwan Kwak , Dong Sun Choi , Jee Hyeon Kim
Department of Emergency Medicine, Seoul Medical Center, Seoul, Korea
Correspondence  Jisun Kim ,Tel: 02-2276-7404, Fax: 02-2276-7418, Email: 30084jisun@seoulmc.or.kr,
Received: July 5, 2022; Revised: October 1, 2022   Accepted: October 21, 2022.  Published online: February 28, 2023.
Early identification of COVID-19 in patients is important to prevent significant worsening of the disease. This study was undertaken to verify whether MEWS (Modified Early Warning Score), NEWS(National Early Warning Score), ROX index, and CURB-65, which are early diagnostic tools for severe respiratory diseases, could be applied to patients visiting the emergency room for COVID-19.
This retrospective observational study included patients who visited an emergency medical center from September 1 to October 31, 2020, and from January 1 to February 28, 2021. Based on the vital signs and blood tests during the emergency room visit, severity evaluation tools and early diagnostic tools for severe cases were used and compared according to their area under the curve (AUC) values. The primary outcome was in-hospital mortality, while the secondary outcomes were intensive care unit admission rate and the need for mechanical ventilation based on these four tools (MEWS, NEWS, ROX index, and CURB-65).
A total of 667 patients were analyzed. No significant difference was determined between the non-survivor group and survivor group in the MEWS values (P=0.13), but statistically significant differences were observed for NEWS (5 vs. 1, P<0.05), CURB-65 (2 vs. 1, P<0.05), and ROX index (16.61 vs. 23.1, P<0.01). The AUC value of NEWS for death prediction indicated a good predictive power at 0.80, while that of MEWS showed a low predictive power at 0.57, which was statistically significant. Moreover, the AUC values of CURB-65 and ROX index did not differ significantly from values obtained for NEWS.
As early diagnostic tools for predicting death in COVID-19 patients, NEWS, ROX index, and CURB-65 showed excellent discrimination ability, whereas MEWS showed statistically and significantly lower discrimination ability.
Key words: Early Warning Score; COVID-19
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