The COVID‐19 Worsening Score (COWS)—a predictive bedside tool for critical illness

Objectives To evaluate the accuracy of a new COVID-19 prognostic score based on lung ultrasound (LUS) and previously validated variables in predicting critical illness. Methods We conducted single-center retrospective cohort development internal validation study Worsening Score (COWS), combination COVID-GRAM (GRAM) LUS. Adult patients admitted to emergency department (ED) were enrolled. Ten identified by GRAM, days from symptom onset, LUS findings, peripheral oxygen saturation/fraction inspired (P/F) ratio analyzed. as single predictor was assessed. evaluated GRAM model's performance, impact adding LUS, then developed model most predictive variables. Results Among 274 enrolled, 174 The 51 at high risk developing illness 132 low risk. over 15 (range 0 36) associated with higher (RR, 2.05; 95% confidence interval [CI], 1.52-2.77; area under curve [AUC], 0.63; CI 0.676-0.634). newly relies five classify high- low-risk an overall 80% negative value 93% (95% CI, 87%-98%). Patients scoring more than 0.183 COWS showed RR 8.07 4.97-11.1). Conclusions accurately identify who are unlikely need intensive care unit (ICU) admission, preserving resources for remaining high-risk patients.