Outpatient Management of Patients With COVID-19: Multicenter Prospective Validation of the Hospitalization or Outpatient Management of Patients With SARS-CoV-2 Infection Rule to Discharge Patients Safely
| Autor: | Delphine Douillet, Andrea Penaloza, Rafaël Mahieu, François Morin, Anthony Chauvin, Stéphane Gennai, Thibault Schotte, Emmanuel Montassier, Pierre-Clément Thiebaud, Alexandre Ghuysen François, David Dall’acqua, Kasarra Benhammouda, Pascal Bissokele, Mathieu Violeau, Luc-Marie Joly, Hery Andrianjafy, Caroline Soulie, Dominique Savary, Jérémie Riou, Pierre-Marie Roy, H. Andrianjafy, L. Baudin, K. Benhammouda, P. Bissolokele, C. Brice, C. Cayeux, E. Casalino, C. Casarin, A. Chauvin, C. Choquet, Y.-E. Claessens, Francis Couturaud, D. Dall’acqua, B. Dobanton, D. Douillet, F. Dupriez, X. Eyer, L. Ferrand, S. Gennai, A. Ghuysen, A. Greau-Chauchet, L.-M. Joly, H.-H. Karam, M. Layot, A. Leroy, R. Lopez, R. Mahieu, N. Marchant, N. Marjanovic, E. Montassier, F. Morin, Baeza A. Penaloza, G. Plantefeve, P.-M. Roy, D. Savary, J. Schmidt, T. Schotte, M. Sebbane, C. Soulie, L. Soulat, C. Steiner, P.-C. Thiebaud, E. Timsit, E. Trabattoni, M. Violeau |
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| Přispěvatelé: | UCL - SSS/IREC/EPID - Pôle d'épidémiologie et biostatistique, UCL - (SLuc) Service des urgences |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
RT-PCR
reverse-transcriptase polymerase chain reaction Pulmonary and Respiratory Medicine Male medicine.medical_specialty Coronavirus disease 2019 (COVID-19) Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) HOME-CoV Hospitalization or Outpatient Management of Patients With SARS-CoV-2 Infection Critical Care and Intensive Care Medicine AUC area under the receiver operating characteristic curve 03 medical and health sciences 0302 clinical medicine Outpatients Ambulatory Care Medicine Humans 030212 general & internal medicine Pandemics expert consensus Receiver operating characteristic business.industry SARS-CoV-2 WHO OSCI World Health Organization Ordinal Scale for Clinical Improvement COVID-19 Disease Management rule validation Middle Aged Decision Support Systems Clinical Hospitals Checklist Patient Discharge 3. Good health Hospitalization clinical support decision tool Editorial 030228 respiratory system Propensity score matching Emergency medicine outpatient rule-based decision-making Very low risk Observational study Female Chest Infections: Original Research Cardiology and Cardiovascular Medicine business Outpatient management hospitalization |
| Zdroj: | Chest, Vol. 160, no. 4, p. 1222-1231 (2021) Chest Chest, Vol. 160, no.4, p. 1222-1231 (2021) |
| Popis: | BACKGROUND: The Hospitalization or Outpatient Management of Patients With SARS-CoV-2 Infection (HOME-CoV) rule is a checklist of eligibility criteria for home treatment of patients with COVID-19, defined using a Delphi method. RESEARCH QUESTION: Is the HOME-CoV rule reliable for identifying a subgroup of COVID-19 patients with a low risk of adverse outcomes who can be treated at home safely? STUDY DESIGN AND METHODS: We aimed to validate the HOME-CoV rule in a prospective, multicenter study before and after trial of patients with probable or confirmed COVID-19 who sought treatment at the ED of 34 hospitals. The main outcome was an adverse evolution, that is, invasive ventilation or death, occurring within the 7 days after patient admission. The performance of the rule was assessed by the false-negative rate. The impact of the rule implementation was assessed by the absolute differences in the rate of patients who required invasive ventilation or who died and in the rate of patients treated at home, between an observational and an interventional period after implementation of the HOME-CoV rule, with propensity score adjustment. RESULTS: Among 3,000 prospectively enrolled patients, 1,239 (41.3%) demonstrated a negative HOME-CoV rule finding. The false-negative rate of the HOME-CoV rule was 4 in 1,239 (0.32%; 95% CI, 0.13%-0.84%), and its area under the receiver operating characteristic curve was 80.9 (95% CI, 76.5-85.2). On the adjusted populations, 25 of 1,274 patients (1.95%) experienced an adverse evolution during the observational period vs 12 of 1,274 patients (0.95%) during the interventional period: -1.00 (95% CI, -1.86 to -0.15). During the observational period, 858 patients (67.35%) were treated at home vs 871 patients (68.37%) during the interventional period: -1.02 (95% CI, -4.46 to 2.26). INTERPRETATION: A large proportion of patients treated in the ED with probable or confirmed COVID-19 have a negative HOME-CoV rule finding and can be treated safely at home with a very low risk of complications. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT04338841; URL: www.clinicaltrials.gov. |
| Databáze: | OpenAIRE |
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