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

Abstract

Background: It is necessary to identify critical patients requiring hospitalization early due to the rapid increase in the number of COVID-19 cases. Aim: This study aims to evaluate the effectiveness of scoring systems such as emergency department triage early warning score (TREWS) and modified early warning score (MEWS) in predicting mortality in COVID-19 patients. Methods: In this retrospective cohort study, PCR positive patients evaluated for COVID-19 and decided to be hospitalized were evaluated. During the first evaluation, MEWS and TREWS scores of the patients were calculated. Intensive care needs as well as 24-h and 28-day mortality rates were evaluated. Results: A total of 339 patients were included in the study. While 30 (8.8%) patients were hospitalized in the intensive care unit, 4 (1.2%) died in the emergency. The number of patients who died within 28 days was found to be 57 (16.8%). In 24-h mortality, the median MEWS value was found to be 7 (IQR 25–75) while the TREWS value was 11.5 (IQR 25–75). In the ROC analysis made for the diagnostic value of 28-day mortality of MEWS and TREWS scores, the area under the curve (AUC) for the MEWS score was found to be 0.833 (95% CI 0.777–0.888, p < 0.001) while it was identified as 0.823 (95% CI 0.764–0.882, p < 0.001) for the TREWS. Conclusion: MEWS and TREWS calculated at emergency services are effective in predicting 28-day mortality in patients requiring hospitalization due to COVID-19.