Identifying patients with symptoms suspicious for COVID-19 at elevated risk of adverse events: The COVAS score.

Autor: Sharp AL; Department of Research and Evaluation, Kaiser Permanente Southern California, 100 South Los Robles, Pasadena, CA 91101, United States of America; Southern California Permanente Medical Group, Los Angeles Medical Center, 4867 Sunset Blvd, Los Angeles, CA 90027, United States of America; Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Health Systems Science, 98 S. Los Robles Ave., Pasadena, CA 91101, United States of America. Electronic address: adam.l.sharp@kp.org., Huang BZ; Department of Research and Evaluation, Kaiser Permanente Southern California, 100 South Los Robles, Pasadena, CA 91101, United States of America. Electronic address: Brian.Huang@kp.org., Broder B; Southern California Permanente Medical Group, Baldwin Park Medical Center, 1011 Baldwin Park Blvd, Baldwin, Park, CA 91706, United States of America. Electronic address: Benjamin.I.Broder@kp.org., Smith M; Southern California Permanente Medical Group, Los Angeles Medical Center, 4867 Sunset Blvd, Los Angeles, CA 90027, United States of America. Electronic address: Matthew.P.Smith@kp.org., Yuen G; Southern California Permanente Medical Group, Baldwin Park Medical Center, 1011 Baldwin Park Blvd, Baldwin, Park, CA 91706, United States of America. Electronic address: George.X.Yuen@kp.org., Subject C; Southern California Permanente Medical Group, Los Angeles Medical Center, 4867 Sunset Blvd, Los Angeles, CA 90027, United States of America. Electronic address: Christopher.C.Subject@kp.org., Nau C; Department of Research and Evaluation, Kaiser Permanente Southern California, 100 South Los Robles, Pasadena, CA 91101, United States of America; Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Health Systems Science, 98 S. Los Robles Ave., Pasadena, CA 91101, United States of America. Electronic address: Claudia.L.Nau@kp.org., Creekmur B; Department of Research and Evaluation, Kaiser Permanente Southern California, 100 South Los Robles, Pasadena, CA 91101, United States of America. Electronic address: Beth.Creekmur@kp.org., Tartof S; Department of Research and Evaluation, Kaiser Permanente Southern California, 100 South Los Robles, Pasadena, CA 91101, United States of America. Electronic address: Sara.Y.Tartof@kp.org., Gould MK; Department of Research and Evaluation, Kaiser Permanente Southern California, 100 South Los Robles, Pasadena, CA 91101, United States of America; Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Health Systems Science, 98 S. Los Robles Ave., Pasadena, CA 91101, United States of America. Electronic address: Michael.K.Gould@kp.org.
Jazyk: angličtina
Zdroj: The American journal of emergency medicine [Am J Emerg Med] 2021 Aug; Vol. 46, pp. 489-494. Date of Electronic Publication: 2020 Nov 05.
DOI: 10.1016/j.ajem.2020.10.068
Abstrakt: Objective: Develop and validate a risk score using variables available during an Emergency Department (ED) encounter to predict adverse events among patients with suspected COVID-19.
Methods: A retrospective cohort study of adult visits for suspected COVID-19 between March 1 - April 30, 2020 at 15 EDs in Southern California. The primary outcomes were death or respiratory decompensation within 7-days. We used least absolute shrinkage and selection operator (LASSO) models and logistic regression to derive a risk score. We report metrics for derivation and validation cohorts, and subgroups with pneumonia or COVID-19 diagnoses.
Results: 26,600 ED encounters were included and 1079 experienced an adverse event. Five categories (comorbidities, obesity/BMI ≥ 40, vital signs, age and sex) were included in the final score. The area under the curve (AUC) in the derivation cohort was 0.891 (95% CI, 0.880-0.901); similar performance was observed in the validation cohort (AUC = 0.895, 95% CI, 0.874-0.916). Sensitivity ranging from 100% (Score 0) to 41.7% (Score of ≥15) and specificity from 13.9% (score 0) to 96.8% (score ≥ 15). In the subgroups with pneumonia (n = 3252) the AUCs were 0.780 (derivation, 95% CI 0.759-0.801) and 0.832 (validation, 95% CI 0.794-0.870), while for COVID-19 diagnoses (n = 2059) the AUCs were 0.867 (95% CI 0.843-0.892) and 0.837 (95% CI 0.774-0.899) respectively.
Conclusion: Physicians evaluating ED patients with pneumonia, COVID-19, or symptoms suspicious for COVID-19 can apply the COVAS score to assist with decisions to hospitalize or discharge patients during the SARS CoV-2 pandemic.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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