CovHos, a New Score to Predict the Need of Hospitalization for Coronavirus Disease 2019 (COVID-19) Patients at the Emergency Department

Derivation and validation of a clinical decision rule to risk-stratify COVID-19 patients discharged from the emergency department: The CCEDRRN COVID discharge score

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.

CovHos score for predicting severe respiratory failure in COVID-19 patients presenting at the emergency department

Hospitalization of COVID-19 patients in low-intensity wards may put patients at risk in case of clinical deterioration. We tested CovHos score in predicting severe respiratory failure (SFR) at emergency department (ED) admission. This is a monocentric observational prospective study enrolling adult COVID-19 patients admitted to the ED of IRCCS AOU di Bologna Policlinico S.Orsola in October 2020, both discharged and hospitalized. Patients were then dichotomized based on days from symptoms onset. Main outcome was the occurrence of SRF. Receiver operating characteristic (ROC) analysis was used to identify cut-off and corresponding accuracy. A CovHos cut-off of 22 yielded a sensitivity of 84.7% and specificity of 75.3% in predicting SRF (AUROC 0.856; CI 95% 0.813-0.898). In patients with symptoms onset up to 8 days, a CovHos cut-off of 22 was able to predict SRF with a sensitivity of 91.7% and a specificity of 78.6% (AUROC 0.901; CI 95% 0.861-0.941). Negative predictive value (NPV) was 97.1%. A CovHos score lower than 22, in patients with COVID-19 symptoms onset dated 8 or less days prior to the ED admittance, had a NPV of 97.1% for the development of SRF, meaning that almost none of those patients will evolve into SRF and could be therefore suitable for a lower intensity of care.

A Convenient Risk Prediction Score for COVID-19 for Determining Whether or Not Hospitalization Is Recommended: Kanagawa Admission Priority Assessment Score

Objective Coronavirus disease 2019 (COVID-19) has caused a collapse of the medical care system, with effective triage proving vital. The Kanagawa admission priority assessment score, version-1 (KAPAS-1) and version-2 (KAPAS-2), was developed to determine the need for hospitalization. Patients with a high KAPAS (≥5) are recommended for hospitalization. We retrospectively investigated the correlation between the KAPAS and oxygen requirement during hospitalization. Methods We collected the clinical data of COVID-19 patients admitted between February 5 and December 6, 2020. Patients were divided into two groups: those who required oxygen therapy during hospitalization (OXY) and those who did not (NOXY). We assessed the correlations between the groups and KAPAS-1 and KAPAS-2. Results Overall, 117 COVID-19 patients were analyzed, including 20 OXY and 97 NOXY and 54 high KAPAS-1 and 63 high KAPAS-2. The median KAPAS-1 and KAPAS-2 were significantly higher in OXY than in NOXY (6.5 vs. 3, and 9 vs. 4, respectively). The areas under the receiver operating characteristic curves of KAPAS-1 and KAPAS-2 for oxygen requirement were 0.777 and 0.825, respectively, and the maximum values of Youden's index were 4 and 6, respectively. The proportions of high KAPAS-1 and high KAPAS-2 were significantly higher in OXY than in NOXY (90.0% vs. 37.1%, and 90.0% vs. 46.4%, respectively). Conclusion The KAPAS was significantly correlated with oxygen requirement. Furthermore, the KAPAS may be useful for deciding which patients are most likely to require hospitalization and for selecting non-hospitalized patients who should be carefully monitored.