Differences in symptoms and utility of MEWS score in geriatric patients with COVID-19
Abstract
Introduction: Rational resource management was key to avoiding overcrowding in Coronavirus Infectious Disease 2019 (COVID-19) dedicated wards. The study aimed to identify specific symptoms for aged patients with COVID-19 and assess the utility of the Modified Early Warning Score (MEWS) as a tool that may support decisions within an emergency department (ED).
Material and methods: This was a retrospective analysis of medical records. ED patients with positive antigen tests for COVID-19 infection were identified. Patients’ history, length of stay (LOS) and vital signs were collected. MEWS score was calculated. Age groups were divided as follows: non-geriatric (NG) — aged under 60; geriatric groups (G): G1 — aged 60–74; G2 — aged 75–89; G3 — aged 90 and over.
Results: There were 777 individuals (261 NG and 510 G patients). Symptoms related to pain as well as anosmia and ageusia occurred more often in NG patients. The longest LOS was in G2 — 182 [101–295] minutes. A significantly shorter LOS (51 [24–156] minutes) was recorded in NG (NG vs. G1 p < 0.0001; NG vs. G2 p < 0.0001; NG vs. G3 p = 0.0007). Admission rate was as follow: NG: 17.24%, G1: 50.97%, G2: 61.43%, G3: 54.17. Accuracy parameters for MEWS score (NG vs G, [%]) were as follow: sensitivity (93.18 vs. 91.04), specificity (13.04 vs. 11.79), positive predictive value (18.55 vs. 52.88), negative predictive value (90.00 vs. 54.76).
Conclusions: Geriatric patients spent more time in ED and were admitted more often. Seniors were less likely to experience pain. MEWS is not a valuable tool for supporting decisions concerning the admission or discharge of geriatric patients with COVID-19.
Keywords: emergency departmentSARS-CoV-2COVID-19organization and administrationpatient care management
References
- World Health Organization. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19); World Health Organization: Geneva, Switzerland. 2020.
- Liu K, Chen Y, Lin R, et al. Clinical features of COVID-19 in elderly patients: A comparison with young and middle-aged patients. J Infect. 2020; 80(6): e14–e18.
- Li JY, You Z, Wang Q, et al. The epidemic of 2019-novel-coronavirus (2019-nCoV) pneumonia and insights for emerging infectious diseases in the future. Microbes Infect. 2020; 22(2): 80–85.
- Vakili S, Savardashtaki A, Jamalnia S, et al. Laboratory Findings of COVID-19 Infection are Conflicting in Different Age Groups and Pregnant Women: A Literature Review. Arch Med Res. 2020; 51(7): 603–607.
- Aygun H, Eraybar S. The role of emergency department triage early warning score (TREWS) and modified early warning score (MEWS) to predict in-hospital mortality in COVID-19 patients. Ir J Med Sci. 2022; 191(3): 997–1003.
- Bradley P, Frost F, Tharmaratnam K, et al. NW Collaborative Organisation for Respiratory Research. Utility of established prognostic scores in COVID-19 hospital admissions: multicentre prospective evaluation of CURB-65, NEWS2 and qSOFA. BMJ Open Respir Res. 2020; 7(1).
- Anurag A, Preetam M. Validation of PSI/PORT, CURB-65 and SCAP scoring system in COVID-19 pneumonia for prediction of disease severity and 14-day mortality. Clin Respir J. 2021; 15(5): 467–471.
- Gandini O, Lubrano C. Use of rapid ferritin test to predict clinical deterioration in at home COVID-19 patients. J Infect. 2021; 82(3): e11–e13.
- Wang L, Lv Q, Zhang X, et al. The utility of MEWS for predicting the mortality in the elderly adults with COVID-19: a retrospective cohort study with comparison to other predictive clinical scores. PeerJ. 2020; 8: e10018.
- Çalıca Utku A, Budak G, Karabay O, et al. Main symptoms in patients presenting in the COVID-19 period. Scott Med J. 2020; 65(4): 127–132.
- Guan WJ, Ni ZY, Hu Yu, et al. China Medical Treatment Expert Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020; 382(18): 1708–1720.
- Grant MC, Geoghegan L, Arbyn M, et al. The prevalence of symptoms in 24,410 adults infected by the novel coronavirus (SARS-CoV-2; COVID-19): A systematic review and meta-analysis of 148 studies from 9 countries. PLoS One. 2020; 15(6): e0234765.
- Dyussenbayev A. Age Periods Of Human Life. Advances in Social Sciences Research Journal. 2017; 4(6).
- Flisiak R, Horban A, Jaroszewicz J, et al. Management of SARS-CoV-2 infection: recommendations of the Polish Association of Epidemiologists and Infectiologists as of March 31, 2020. Pol Arch Intern Med. 2020; 130(4): 352–357.
- Vaira LA, Salzano G, Deiana G, et al. Anosmia and Ageusia: Common Findings in COVID-19 Patients. Laryngoscope. 2020; 130(7): 1787.
- Sampaio Rocha-Filho PA, Voss L. Persistent Headache and Persistent Anosmia Associated With COVID-19. Headache. 2020; 60(8): 1797–1799.
- Kennedy M, Helfand BKI, Gou RY, et al. Delirium in Older Patients With COVID-19 Presenting to the Emergency Department. JAMA Netw Open. 2020; 3(11): e2029540.
- Rebora P, Rozzini R, Bianchetti A, et al. CoViD-19 Lombardia Team. Delirium in Patients with SARS-CoV-2 Infection: A Multicenter Study. J Am Geriatr Soc. 2021; 69(2): 293–299.
- Kłosiewicz T, Szkudlarek W, Węglewska M, et al. Dynamics of the Third Wave of COVID-19 from the Perspective of the Emergency Department in a Large Regional Hospital-Single Center Observational Study. Healthcare (Basel). 2021; 10(1).
- Barnett WR, Radhakrishnan M, Macko J, et al. Initial MEWS score to predict ICU admission or transfer of hospitalized patients with COVID-19: A retrospective study. J Infect. 2021; 82(2): 282–327.
- Covino M, Sandroni C, Santoro M, et al. Predicting intensive care unit admission and death for COVID-19 patients in the emergency department using early warning scores. Resuscitation. 2020; 156: 84–91.
- Gul MH, Htun ZM, Inayat A. Role of fever and ambient temperature in COVID-19. Expert Rev Respir Med. 2021; 15(2): 171–173.
- Flisiak R, Horban A, Jaroszewicz J, et al. Zalecenia dotyczące postępowania w zakażeniach SARS-CoV-2 Polskiego Towarzystwa Epidemiologów i Lekarzy Chorób Zakaźnych z 23 lutego 2022 roku. Med. Prakt. 2022; 3: 49–77.