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Abstract
The evolution of the COVID-19 pandemic has been associated with variations in clinical presentation and severity. Similarly, prediction scores may suffer changes in their diagnostic accuracy. The aim of this study was to test the 30-day mortality predictive validity of the 4C and SEIMC scores during the sixth wave of the pandemic and to compare them with those of validation studies. This was a longitudinal retrospective observational study. COVID-19 patients who were admitted to the Emergency Department of a Spanish hospital from December 15, 2021, to January 31, 2022, were selected. A side-by-side comparison with the pivotal validation studies was subsequently performed. The main measures were 30-day mortality and the 4C and SEIMC scores. A total of 27,614 patients were considered in the study, including 22,361 from the 4C, 4,627 from the SEIMC and 626 from our hospital. The 30-day mortality rate was significantly lower than that reported in the validation studies. The AUCs were 0.931 (95% CI: 0.90–0.95) for 4C and 0.903 (95% CI: 086–0.93) for SEIMC, which were significantly greater than those obtained in the first wave. Despite the changes that have occurred during the coronavirus disease 2019 (COVID-19) pandemic, with a reduction in lethality, scorecard systems are currently still useful tools for detecting patients with poor disease risk, with better prognostic capacity.
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1 Hospital Clínico Universitario de Valladolid, Emergency Department, Valladolid, Spain (GRID:grid.411057.6) (ISNI:0000 0000 9274 367X)
2 Hospital Clínico Universitario de Valladolid, Emergency Department, Valladolid, Spain (GRID:grid.411057.6) (ISNI:0000 0000 9274 367X); University of Valladolid, Faculty of Medicine, Valladolid, Spain (GRID:grid.5239.d) (ISNI:0000 0001 2286 5329)
3 University of Castilla la Mancha, Faculty of Health Sciences, Talavera de la Reina, Spain (GRID:grid.8048.4) (ISNI:0000 0001 2194 2329)
4 University of Valladolid, Faculty of Medicine, Valladolid, Spain (GRID:grid.5239.d) (ISNI:0000 0001 2286 5329)
5 Universidad Europea del Atlántico, Santander, Spain (GRID:grid.512306.3) (ISNI:0000 0004 4681 9396); Universidad Internacional Iberoamericana, Arecibo, USA (GRID:grid.512306.3) (ISNI:0000 0004 0459 7019); Universidad de La Romana, La Romana, República Dominicana (GRID:grid.512306.3)
6 Universidad Europea del Atlántico, Santander, Spain (GRID:grid.512306.3) (ISNI:0000 0004 4681 9396); Universidad Internacional Iberoamericana, Campeche, Mexico (GRID:grid.512306.3) (ISNI:0000 0004 9335 3701); Universidade Internacional do Cuanza. Cuito, Bié, Angola (GRID:grid.512306.3) (ISNI:0000 0004 9335 6881)
7 Universidad Europea del Atlántico, Santander, Spain (GRID:grid.512306.3) (ISNI:0000 0004 4681 9396); Universidade Internacional do Cuanza. Cuito, Bié, Angola (GRID:grid.512306.3) (ISNI:0000 0004 9335 6881); Fundación Universitaria Internacional de Colombia, Bogotá, Colombia (GRID:grid.512306.3) (ISNI:0000 0004 7717 0446)
8 University of Valladolid, Faculty of Medicine, Valladolid, Spain (GRID:grid.5239.d) (ISNI:0000 0001 2286 5329); Emergency Medical Services (SACYL), Advanced Life Support, Valladolid, Spain (GRID:grid.5239.d)