TY - JOUR T1 - Prospective predictive performance comparison between clinical gestalt and validated COVID-19 mortality scores JF - Journal of Investigative Medicine JO - J Investig Med DO - 10.1136/jim-2021-002037 SP - jim-2021-002037 AU - Adrian Soto-Mota AU - Braulio Alejandro Marfil-Garza AU - Santiago Castiello-de Obeso AU - Erick Jose Martinez Rodriguez AU - Daniel Alberto Carrillo Vazquez AU - Hiram Tadeo-Espinoza AU - Jessica Paola Guerrero Cabrera AU - Francisco Eduardo Dardon-Fierro AU - Juan Manuel Escobar-Valderrama AU - Jorge Alanis-Mendizabal AU - Juan Gutierrez-Mejia Y1 - 2021/10/06 UR - http://hw-f5-jim.highwire.org/content/early/2021/10/06/jim-2021-002037.abstract N2 - Most COVID-19 mortality scores were developed at the beginning of the pandemic and clinicians now have more experience and evidence-based interventions. Therefore, we hypothesized that the predictive performance of COVID-19 mortality scores is now lower than originally reported. We aimed to prospectively evaluate the current predictive accuracy of six COVID-19 scores and compared it with the accuracy of clinical gestalt predictions. 200 patients with COVID-19 were enrolled in a tertiary hospital in Mexico City between September and December 2020. The area under the curve (AUC) of the LOW-HARM, qSOFA, MSL-COVID-19, NUTRI-CoV, and NEWS2 scores and the AUC of clinical gestalt predictions of death (as a percentage) were determined. In total, 166 patients (106 men and 60 women aged 56±9 years) with confirmed COVID-19 were included in the analysis. The AUC of all scores was significantly lower than originally reported: LOW-HARM 0.76 (95% CI 0.69 to 0.84) vs 0.96 (95% CI 0.94 to 0.98), qSOFA 0.61 (95% CI 0.53 to 0.69) vs 0.74 (95% CI 0.65 to 0.81), MSL-COVID-19 0.64 (95% CI 0.55 to 0.73) vs 0.72 (95% CI 0.69 to 0.75), NUTRI-CoV 0.60 (95% CI 0.51 to 0.69) vs 0.79 (95% CI 0.76 to 0.82), NEWS2 0.65 (95% CI 0.56 to 0.75) vs 0.84 (95% CI 0.79 to 0.90), and neutrophil to lymphocyte ratio 0.65 (95% CI 0.57 to 0.73) vs 0.74 (95% CI 0.62 to 0.85). Clinical gestalt predictions were non-inferior to mortality scores, with an AUC of 0.68 (95% CI 0.59 to 0.77). Adjusting scores with locally derived likelihood ratios did not improve their performance; however, some scores outperformed clinical gestalt predictions when clinicians’ confidence of prediction was <80%. Despite its subjective nature, clinical gestalt has relevant advantages in predicting COVID-19 clinical outcomes. The need and performance of most COVID-19 mortality scores need to be evaluated regularly.Data are available upon reasonable request. ER -