ArticleEchocardiography (Mount Kisco, N.Y.)2021
The COVID-19 Worsening Score (COWS)-a predictive bedside tool for critical illness.
Article in Echocardiography (Mount Kisco, N.Y.), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 3 of them syntheses that pooled it.
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Who cites it
21 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Lung ultrasound score severity cut-off points in COVID-19 pneumonia. A systematic review and validating cohort.Medicina clinica · 2023Pooled it
- Prognostic models in COVID-19 infection that predict severity: a systematic review.European journal of epidemiology · 2023Pooled it
- Ultrasound findings of lung ultrasonography in COVID-19: A systematic review.European journal of radiology · 2022Pooled it
- Lung ultrasound performed by primary care physicians as a predictive and diagnostic tool in COVID-19 patients.NPJ primary care respiratory medicine · 2026Observational
- Diagnostic and Prognostic Value of Lung Ultrasound Performed by Non-Expert Staff in Patients with Acute Dyspnea.Diagnostics (Basel, Switzerland) · 2025Article
- We Need to Talk About Lung Ultrasound Score: Prediction of Intensive Care Unit Admission with Machine Learning.Journal of imaging · 2025Article
- To B or not to B-lines.Journal of anesthesia, analgesia and critical care · 2024Article
- Lung ultrasound among Expert operator'S: ScOring and iNter-rater reliability analysis (LESSON study) a secondary COWS study analysis from ITALUS group.Journal of anesthesia, analgesia and critical care · 2024Article
- Evaluation of a Lung Ultrasound Score in Hospitalized Adult Patients with COVID-19 in Barcelona, Spain.Journal of clinical medicine · 2024Article
- Point-of-care ultrasound use in COVID-19: a narrative review.Annals of translational medicine · 2024Review
- Lung ultrasound score severity cut-off points in COVID-19 pneumonia. A systematic review and validating cohort.Medicina clinica (English ed.) · 2023Article
- COVID-19 Lung Ultrasound Scores and Lessons from the Pandemic: A Narrative Review.Diagnostics (Basel, Switzerland) · 2023Review
- Pulmonary hypertension at admission predicts ICU mortality in elderly critically ill with severe COVID-19 pneumonia: retrospective cohort study.Cardiovascular ultrasound · 2023Observational
- Level of Diffusion and Training of Lung Ultrasound during the COVID-19 Pandemic - A National Online Italian Survey (ITALUS) from the Lung Ultrasound Working Group of the Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI).Ultraschall in der Medizin (Stuttgart, Germany : 1980) · 2022Article
- Point-of-Care Ultrasound Predicts Clinical Outcomes in Patients With COVID-19.Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine · 2022Article
- Lung ultrasound findings following COVID-19 hospitalization: A prospective longitudinal cohort study.Respiratory medicine · 2022Article
- Heterogeneity and Risk of Bias in Studies Examining Risk Factors for Severe Illness and Death in COVID-19: A Systematic Review and Meta-Analysis.Pathogens (Basel, Switzerland) · 2022Review
- Lung Ultrasound Findings Associated With COVID-19 ARDS, ICU Admission, and All-Cause Mortality.Respiratory care · 2022Observational
- Lung Ultrasound, Clinical and Analytic Scoring Systems as Prognostic Tools in SARS-CoV-2 Pneumonia: A Validating Cohort.Diagnostics (Basel, Switzerland) · 2021Article
- Learning from the Italian experience during COVID-19 pandemic waves: be prepared and mind some crucial aspects.Acta bio-medica : Atenei Parmensis · 2021Review
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Authors and funding
18 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo evaluate the accuracy of a new COVID-19 prognostic score based on lung ultrasound (LUS) and previously validated variables in predicting critical illness.
methodsWe conducted a single-center retrospective cohort development and internal validation study of the COVID-19 Worsening Score (COWS), based on a combination of the previously validated COVID-GRAM score (GRAM) variables and LUS. Adult COVID-19 patients admitted to the emergency department (ED) were enrolled. Ten variables previously identified by GRAM, days from symptom onset, LUS findings, and peripheral oxygen saturation/fraction of inspired oxygen (P/F) ratio were analyzed. LUS score as a single predictor was assessed. We evaluated GRAM model's performance, the impact of adding LUS, and then developed a new model based on the most predictive variables.
resultsAmong 274 COVID-19 patients enrolled, 174 developed critical illness. The GRAM score identified 51 patients at high risk of developing critical illness and 132 at low risk. LUS score over 15 (range 0 to 36) was associated with a higher risk ratio of critical illness (RR, 2.05; 95% confidence interval [CI], 1.52-2.77; area under the curve [AUC], 0.63; 95% CI 0.676-0.634). The newly developed COVID-19 Worsening Score relies on five variables to classify high- and low-risk patients with an overall accuracy of 80% and negative predictive value of 93% (95% CI, 87%-98%). Patients scoring more than 0.183 on COWS showed a RR of developing critical illness of 8.07 (95% CI, 4.97-11.1).
conclusionsCOWS accurately identify patients who are unlikely to need intensive care unit (ICU) admission, preserving resources for the remaining high-risk patients.
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