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Douillet D, Riou J, Morin F, Mahieu R, Chauvin A, Gennai S, Ferrant L, Lopez R, Sebbane M, Plantefeve G, Brice C, Cayeux C, Savary D, Moumneh T, Penaloza A, Roy PM. Derivation and validation of a risk-stratification model for patients with probable or proven COVID-19 in EDs: the revised HOME-CoV score. Emerg Med J 2024; 41:218-225. [PMID: 38365436 DOI: 10.1136/emermed-2022-212631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND The HOME-CoV (Hospitalisation or Outpatient ManagEment of patients with SARS-CoV-2 infection) score is a validated list of uniquely clinical criteria indicating which patients with probable or proven COVID-19 can be treated at home. The aim of this study was to optimise the score to improve its ability to discriminate between patients who do and do not need admission. METHODS A revised HOME-CoV score was derived using data from a previous prospective multicentre study which evaluated the original Home-CoV score. Patients with proven or probable COVID-19 attending 34 EDs in France, Monaco and Belgium between April and May 2020 were included. The population was split into a derivation and validation sample corresponding to the observational and interventional phases of the original study. The main outcome was non-invasive or invasive ventilation or all-cause death within 7 days following inclusion. Two threshold values were defined using a sensitivity of >0.9 and a specificity of >0.9 to identify low-risk and high-risk patients, respectively. The revised HOME-CoV score was then validated by retrospectively applying it to patients in the same EDs with proven or probable COVID-19 during the interventional phase. The revised HOME-CoV score was also tested against original HOME-CoV, qCSI, qSOFA, CRB65 and SMART-COP in this validation cohort. RESULTS There were 1696 patients in the derivation cohort, of whom 65 (3.8%) required non-invasive ventilation or mechanical ventilation or died within 7 days and 1304 patients in the validation cohort, of whom 22 (1.7%) had a progression of illness. The revised score included seven clinical criteria. The area under the curve (AUC) was 87.6 (95% CI 84.7 to 90.6). The cut-offs to define low-risk and high-risk patients were <2 and >3, respectively. In the validation cohort, the AUC was 85.8 (95% CI 80.6 to 91.0). A score of <2 qualified 73% of patients as low risk with a sensitivity of 0.77 (0.55-0.92) and a negative predictive value of 0.99 (0.99-1.00). CONCLUSION The revised HOME-CoV score, which does not require laboratory testing, may allow accurate risk stratification and safely qualify a significant proportion of patients with probable or proven COVID-19 for home treatment.
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Affiliation(s)
- Delphine Douillet
- Emergency Department, CHU Angers, University of Angers, CHU Angers, Angers, France
- UMR MitoVasc CNRS 6015 - INSERM 1083, Health Faculty, University of Angers; FCRIN, INNOVTE, Universite Angers Faculte des sciences, Angers, France
| | - Jérémie Riou
- Micro et Nano médecines Translationnelles, MINT, UNIV Angers, UMR INSERM 1066, UMR CNRS 6021, CHU Angers, Angers, France
- Methodology and Biostatistics Department, Delegation to Clinical Research and Innovation, Angers University Hospital, Université Angers Faculté des Sciences, Angers, France
| | - François Morin
- Emergency Department, CHU Angers, University of Angers, CHU Angers, Angers, France
| | - Rafaël Mahieu
- Department of Infectious Disease, Angers University Hospital; University of Angers, CHU Angers, Angers, France
- CRCINA, Inserm U1232, University of Nantes-Angers, Universite Angers Faculte Des Sciences, Angers, France
| | - Anthony Chauvin
- Emergency Department, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Assistance Publique - Hopitaux de Paris, Paris, France
| | - Stéphane Gennai
- Emergency Department, Reims University Hospital, University Hospital Centre Reims, Reims, France
- UFR Médecine, Université de Reims Champagne-Ardenne, Reims, France
| | - Lionel Ferrant
- Emergency Department, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Raphaëlle Lopez
- Emergency Department, Sart Tilman University Hospital, Centre hospitalier universitaire de Liège, Liege, Belgium
| | - Mustapha Sebbane
- Emergency Department, Montpellier University Hospital, Montpellier, France
| | | | - Christian Brice
- Emergency Department, Centre Hospitalier de Saint Brieuc, Saint Brieuc, France
| | - Coralie Cayeux
- Emergency Department, Centre Hospitalier de Remiremont, Remiremont, France
| | - Dominique Savary
- Department of Emergency Medicine, University of Angers, ANGERS, France
- Inserm IRSET UMR_S1085, I, EHESP, Angers, France
| | | | - Andrea Penaloza
- Emergency, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Pierre Marie Roy
- Emergency Department, CHU Angers, University of Angers, CHU Angers, Angers, France
- UMR MitoVasc CNRS 6015 - INSERM 1083, Health Faculty, University of Angers; FCRIN, INNOVTE, Universite Angers Faculte des sciences, Angers, France
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Clinical Characteristics and Management of Patients with a Suspected COVID-19 Infection in Emergency Departments: A European Retrospective Multicenter Study. J Pers Med 2022; 12:jpm12122085. [PMID: 36556305 PMCID: PMC9787691 DOI: 10.3390/jpm12122085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/21/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Our aim is to describe and compare the profile and outcome of patients attending the ED with a confirmed COVID-19 infection with patients with a suspected COVID-19 infection. Methods: We conducted a multicentric retrospective study including adults who were seen in 21 European emergency departments (ED) with suspected COVID-19 between 9 March and 8 April 2020. Patients with either a clinical suspicion of COVID-19 or confirmed COVID-19, detected using either a RT-PCR or a chest CT scan, formed the C+ group. Patients with non-confirmed COVID-19 (C− group) were defined as patients with a clinical presentation in the ED suggestive of COVID-19, but if tests were performed, they showed a negative RT-PCR and/or a negative chest CT scan. Results: A total of 7432 patients were included in the analysis: 1764 (23.7%) in the C+ group and 5668 (76.3%) in the C− group. The population was older (63.8 y.o. ±17.5 vs. 51.8 y.o. +/− 21.1, p < 0.01), with more males (54.6% vs. 46.1%, p < 0.01) in the C+ group. Patients in the C+ group had more chronic diseases. Half of the patients (n = 998, 56.6%) in the C+ group needed oxygen, compared to only 15% in the C− group (n = 877). Two-thirds of patients from the C+ group were hospitalized in ward (n = 1128, 63.9%), whereas two-thirds of patients in the C− group were discharged after their ED visit (n = 3883, 68.5%). Conclusion: Our study was the first in Europe to examine the emergency department’s perspective on the management of patients with a suspected COVID-19 infection. We showed an overall more critical clinical situation group of patients with a confirmed COVID-19 infection.
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Morello F, Bima P, Giamello JD, Baricocchi D, Risi F, Vesan M, Pivetta EE, de Stefano G, Chiarlo M, Veglia S, Schivazappa G, Mengozzi G, Lauria G, Podio S, Nazerian P, Aprà F, Ferreri E, Lupia E. A 4C mortality score based dichotomic rule supports Emergency Department discharge of COVID-19 patients. Minerva Med 2022; 113:916-926. [PMID: 35191293 DOI: 10.23736/s0026-4806.21.07779-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND For COVID-19 patients evaluated in the Emergency Department (ED), decision on hospital admission vs. home discharge is challenging. The 4C mortality score (4CMS) is a prognostication tool integrating key demographic/clinical/biochemical data validated for COVID-19 inpatients. We sought to derive and validate a dichotomic rule based on 4CMS identifying patients with mild outcomes, suitable for safe ED discharge. METHODS Derivation was performed in a prospective cohort of ED patients with suspected COVID-19 from two centers (April 2020). Validation was pursued in a prospective multicenter cohort of ED patients with confirmed COVID-19 from 6 centers (October 2020 to January 2021). Chest X-ray (CXR) images were independently scored. The primary composite outcome was all-cause 30-day mortality or hospital admission. Secondary outcomes were ED re-visit, oxygen therapy and ventilation. RESULTS In a derivation cohort of 838 ED patients with suspected COVID-19, 4CMS≤8 was associated with low outpatient mortality (0.4%) and was thus selected as a feasible discharge rule. In a validation cohort of 521 COVID-19 outpatients, the mean age was 51±17 years; 97 (18.6%) patients had ≥1 CXR infiltrate. The 4CMS had an AUC of 0.82 for the primary outcome and 0.93 for mortality, outperforming other scores (CURB-65, qCSI, qSOFA, NEWS) and CXR. In 474 (91%) patients with 4CMS≤8, the mortality rate was 0.2% and the hospital admission rate was 6.8%, versus 12.8% and 36.2% for 4CMS≥9 (P<0.001). CXR did not provide additional discrimination. CONCLUSIONS COVID-19 outpatients with 4CMS≤8 have mild outcomes and can be safely discharged from the ED. [NCT0462918].
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Affiliation(s)
- Fulvio Morello
- Emergency Medicine U Unit, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy - .,Department of Medical Sciences, University of Turin, Turin, Italy -
| | - Paolo Bima
- School of Emergency Medicine, University of Turin, Turin, Italy.,MeCAU Unit, Maria Vittoria Hospital, Turin, Italy
| | - Jacopo D Giamello
- School of Emergency Medicine, University of Turin, Turin, Italy.,Emergency Medicine Unit, A.O. S. Croce e Carle, Cuneo, Italy
| | - Denise Baricocchi
- School of Emergency Medicine, University of Turin, Turin, Italy.,Emergency Medicine Unit, A.O. Parini, Aosta, Italy
| | - Francesca Risi
- Emergency Medicine U Unit, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy.,School of Emergency Medicine, University of Turin, Turin, Italy
| | - Matteo Vesan
- Emergency Medicine U Unit, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy.,School of Emergency Medicine, University of Turin, Turin, Italy
| | - Emanuele E Pivetta
- Emergency Medicine U Unit, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | | | - Michela Chiarlo
- Emergency Medicine Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Simona Veglia
- Unit of Radiology2, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Giulia Schivazappa
- Unit of Radiology2, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Giulio Mengozzi
- Baldi e Riberi Laboratory, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Giuseppe Lauria
- Emergency Medicine Unit, A.O. S. Croce e Carle, Cuneo, Italy
| | | | | | - Franco Aprà
- Emergency Medicine Unit, San Giovanni Bosco Hospital, Turin, Italy
| | | | - Enrico Lupia
- Emergency Medicine U Unit, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy.,Department of Medical Sciences, University of Turin, Turin, Italy
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Brooks SC, Rosychuk RJ, Perry JJ, Morrison LJ, Wiemer H, Fok P, Rowe BH, Daoust R, Vatanpour S, Turner J, Landes M, Ohle R, Hayward J, Scheuermeyer F, Welsford M, Hohl C. Derivation and validation of a clinical decision rule to risk-stratify COVID-19 patients discharged from the emergency department: The CCEDRRN COVID discharge score. J Am Coll Emerg Physicians Open 2022; 3:e12868. [PMID: 36579029 PMCID: PMC9780419 DOI: 10.1002/emp2.12868] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/10/2022] [Accepted: 11/17/2022] [Indexed: 12/24/2022] Open
Abstract
Objective To risk-stratify COVID-19 patients being considered for discharge from the emergency department (ED). Methods We conducted an observational study to derive and validate a clinical decision rule to identify COVID-19 patients at risk for hospital admission or death within 72 hours of ED discharge. We used data from 49 sites in the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) between March 1, 2020, and September 8, 2021. We randomly assigned hospitals to derivation or validation and prespecified clinical variables as candidate predictors. We used logistic regression to develop the score in a derivation cohort and examined its performance in predicting short-term adverse outcomes in a validation cohort. Results Of 15,305 eligible patient visits, 535 (3.6%) experienced the outcome. The score included age, sex, pregnancy status, temperature, arrival mode, respiratory rate, and respiratory distress. The area under the curve was 0.70 (95% confidence interval [CI] 0.68-0.73) in derivation and 0.71 (95% CI 0.68-0.73) in combined derivation and validation cohorts. Among those with a score of 3 or less, the risk for the primary outcome was 1.9% or less, and the sensitivity of using 3 as a rule-out score was 89.3% (95% CI 82.7-94.0). Among those with a score of ≥9, the risk for the primary outcome was as high as 12.2% and the specificity of using 9 as a rule-in score was 95.6% (95% CI 94.9-96.2). Conclusion The CCEDRRN COVID discharge score can identify patients at risk of short-term adverse outcomes after ED discharge with variables that are readily available on patient arrival.
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Affiliation(s)
- Steven C. Brooks
- Departments of Emergency Medicine and Public Health SciencesQueen's UniversityKingstonOntarioCanada
| | | | - Jeffrey J. Perry
- Department of Emergency MedicineUniversity of OttawaOttawaOntarioCanada
| | - Laurie J. Morrison
- Department of Emergency Services, Sunnybrook Health Sciences Centre, Department of Medicine, Division of Emergency MedicineUniversity of TorontoTorontoOntarioCanada
| | - Hana Wiemer
- Department of Emergency MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| | - Patrick Fok
- Department of Emergency MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| | - Brian H. Rowe
- Department of Emergency MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - Raoul Daoust
- Departement de Médecine de Famille et Médecine d'urgenceUniversité de MontréalMontréalQuébecCanada
| | - Shabnam Vatanpour
- Department of Emergency MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Joel Turner
- Department of Emergency MedicineMcGill UniversityMontréalQuébecCanada
| | - Megan Landes
- Department of Family and Community MedicineDivision of Emergency MedicineUniversity of TorontoTorontoOntarioCanada
| | - Robert Ohle
- Department of Emergency Medicine, Health Science North Research InstituteNorthern Ontario School of MedicineSudburyOntarioCanada
| | - Jake Hayward
- Department of Emergency MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - Frank Scheuermeyer
- Department of Emergency MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Michelle Welsford
- Department of Medicine, Division of Emergency MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Corinne Hohl
- Department of Emergency MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
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5
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Kotok D, Robles JR, E Girard C, K Shettigar S, P Lavina A, R Gillenwater S, I Kim A, Hadeh A. Chest Radiograph Severity and Its Association With Outcomes in Subjects With COVID-19 Presenting to the Emergency Department. Respir Care 2022; 67:871-878. [PMID: 35473787 PMCID: PMC9994088 DOI: 10.4187/respcare.09761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Severity of radiographic abnormalities on chest radiograph in subjects with COVID-19 has been shown to be associated with worse outcomes, but studies are limited by different scoring systems, sample size, subject age, and study duration. Data regarding the longitudinal evolution of radiographic abnormalities and its association with outcomes are scarce. We sought to evaluate these questions using a well-validated scoring system (the Radiographic Assessment of Lung Edema [RALE] score) using data over 6 months from a large, multihospital health care system. METHODS We collected clinical and demographic data and quantified radiographic edema on chest radiograph obtained in the emergency department (ED) as well as on days 1-2 and 3-5 (in those admitted) in subjects with a nasopharyngeal swab positive for SARS-CoV-2 by polymerase chain reaction (PCR) visiting the ED for coronavirus disease 2019 (COVID)-19-related complaints between March-September 2020. We examined the association of baseline and longitudinal evolution of radiographic edema with severity of hypoxemia and clinical outcomes. RESULTS Eight hundred and seventy subjects were included (median age 53.6; 50.8% female). Inter-rate agreement for RALE scores was excellent (interclass correlation coefficient 0.84 [95% CI 0.82-0.87], P < .001). RALE scores correlated with hypoxemia as quantified by SpO2 /FIO2 (r = -0.42, P < .001). Admitted subjects had higher RALE scores than those discharged (6 [2-11] vs 0 [0-3], P < .001). An increase of RALE score ≥ 4 was associated with worse 30-d survival (P = .006). Larger increases in the RALE score were associated with worse survival. CONCLUSIONS The RALE score was reproducible and easily implementable in adult subjects presenting to the ED with COVID-19. Its association with physiologic parameters and outcomes at baseline and longitudinally makes it a readily available tool for prognostication and early ICU triage, particularly in patients with worsening radiographic edema.
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Affiliation(s)
- Daniel Kotok
- Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Florida, Weston, Florida.
| | - Jose Rivera Robles
- Department of Internal Medicine, Cleveland Clinic Florida, Weston, Florida
| | - Christine E Girard
- Department of Internal Medicine, Cleveland Clinic Florida, Weston, Florida
| | | | - Allen P Lavina
- Department of Internal Medicine, Cleveland Clinic Florida, Weston, Florida
| | - Samantha R Gillenwater
- Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Florida, Weston, Florida
| | - Andrew I Kim
- Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Florida, Weston, Florida
| | - Anas Hadeh
- Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Florida, Weston, Florida
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Lung Ultrasound Improves Outcome Prediction over Clinical Judgment in COVID-19 Patients Evaluated in the Emergency Department. J Clin Med 2022; 11:jcm11113032. [PMID: 35683419 PMCID: PMC9181775 DOI: 10.3390/jcm11113032] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/19/2022] [Accepted: 05/24/2022] [Indexed: 12/24/2022] Open
Abstract
In the Emergency Department (ED), the decision to hospitalize or discharge COVID-19 patients is challenging. We assessed the utility of lung ultrasound (LUS), alone or in association with a clinical rule/score. This was a multicenter observational prospective study involving six EDs (NCT046291831). From October 2020 to January 2021, COVID-19 outpatients discharged from the ED based on clinical judgment were subjected to LUS and followed-up at 30 days. The primary clinical outcome was a composite of hospitalization or death. Within 393 COVID-19 patients, 35 (8.9%) reached the primary outcome. For outcome prognostication, LUS had a C-index of 0.76 (95%CI 0.68−0.84) and showed good performance and calibration. LUS-based classification provided significant differences in Kaplan−Meier curves, with a positive LUS leading to a hazard ratio of 4.33 (95%CI 1.95−9.61) for the primary outcome. The sensitivity and specificity of LUS for primary outcome occurrence were 74.3% (95%CI 59.8−88.8) and 74% (95%CI 69.5−78.6), respectively. The integration of LUS with a clinical score further increased sensitivity. In patients with a negative LUS, the primary outcome occurred in nine (3.3%) patients (p < 0.001 vs. unselected). The efficiency for rule-out was 69.7%. In unvaccinated ED patients with COVID-19, LUS improves prognostic stratification over clinical judgment alone and may support standardized disposition decisions.
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7
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Douillet D, Riou J, Penaloza A, Moumneh T, Soulie C, Savary D, Morin F, Mahieu R, Roy PM. Risk of symptomatic venous thromboembolism in mild and moderate COVID-19: A comparison of two prospective European cohorts. Thromb Res 2021; 208:4-10. [PMID: 34653718 PMCID: PMC8498792 DOI: 10.1016/j.thromres.2021.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/30/2021] [Accepted: 10/03/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Severely ill patients with SARS-CoV-2 have an increased risk of venous thromboembolism (VTE) i.e., deep vein thrombosis and pulmonary embolism. However, the VTE risk in patients with mild and moderate COVID-19, hospitalized or managed at home, remain uncertain. The aims of this study were to assess the rate and the risk factors symptomatic VTE, in patients with mild and moderate COVID-19 and to compare them to a cohort of similar patients without COVID-19. METHODS Patients presenting to the emergency department (ED) of participating centers for confirmed or probable mild or moderate COVID-19 and not having acute VTE were included. This COVID-19 cohort was retrospectively compared to a prospective cohort of similar ED patients using propensity score matching. The main outcome was the rate of symptomatic VTE within the 28 days after ED presentation. RESULTS A total of 2292 patients were included in the COVID-19 cohort. The 28-day incidence of symptomatic VTE was 1.3% (n = 29/2292, 95%CI: 0.9 to 1.8), 2.3% (n = 20/866, 95%CI: 1.5 to 3.5) in moderate COVID-19 patients and 0.6% (n = 9/1426; 95%CI: 0.3 to 1.2) in mild COVID-19 patients managed as outpatients. An age over 65 years and hospitalization were independent risk factors of VTE. After adjustment, patients in the COVID-19 cohort had an absolute increase in over symptomatic VTE risk of +1.69% (95%CI, 0.88 to 2.51) versus patients in the comparison cohort (n = 1539). CONCLUSIONS Patients with moderate COVID-19 presenting to the ED had a high risk of subsequent VTE. TRIAL REGISTRATION Ethics committee of the CHU of Angers (N°2020/87).
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Affiliation(s)
- Delphine Douillet
- Emergency Department, Angers University Hospital, Angers, France,UNIV Angers, UMR MitoVasc CNRS 6015 - INSERM 1083, Angers, France,FCRIN, INNOVTE, Saint Etienne, France,Corresponding author at: Département de Médecine d'Urgence, Centre Hospitalier Universitaire d'Angers, 4 rue Larrey, 49100 Angers, France
| | - Jérémie Riou
- UNIV Angers, UMR MINT, INSERM 1066 - CNRS 6021, Angers, France,Methodology and Biostatistics Department, Delegation to Clinical Research and Innovation, Angers University Hospital, Angers, France
| | - Andrea Penaloza
- FCRIN, INNOVTE, Saint Etienne, France,Emergency Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Bruxelles, Belgium
| | - Thomas Moumneh
- Emergency Department, Angers University Hospital, Angers, France,UNIV Angers, UMR MitoVasc CNRS 6015 - INSERM 1083, Angers, France,FCRIN, INNOVTE, Saint Etienne, France
| | | | - Dominique Savary
- Emergency Department, Angers University Hospital, Angers, France,EHESP, Irset, UMR INSERM S1085, CAPTV CDC, University of Rennes, Rennes, France
| | - Francois Morin
- Emergency Department, Angers University Hospital, Angers, France
| | - Rafaël Mahieu
- Department of Infectious Diseases, Angers University Hospital, Angers, France,UNIV Angers, UMR CRCINA, INSERM 1232, SFR ICAT, Angers, France
| | - Pierre-Marie Roy
- Emergency Department, Angers University Hospital, Angers, France,UNIV Angers, UMR MitoVasc CNRS 6015 - INSERM 1083, Angers, France,FCRIN, INNOVTE, Saint Etienne, France
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Hospital or Home?: A Pandemic Decision Tool in Context. Chest 2021; 160:1155-1156. [PMID: 34625158 PMCID: PMC8490856 DOI: 10.1016/j.chest.2021.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/15/2021] [Indexed: 11/22/2022] Open
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