A 34-year-old male presented to the emergency department with a 3-hour complaint of pain in the right lower quadrant and right testicle. He stated that his pain began suddenly while standing at work. On physical examination, he had a small, firm, unreducible bulge in his right inguinal canal and an enlarged right scrotum. The patient was placed in trendelenburg position; intravenous fentanyl, valium, and dilaudid were administered; and surgery consult was obtained. A testicular ultrasonogram (Figure) was obtained owing to continued pain in the right scrotum and inability to evaluate the testicle. After viewing the ultrasound pattern, the patient was promptly taken to the operating room 6 hours after onset of symptoms.

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The health care system is composed of a mix of 2 community and 4 academics EDs in a major metropolitan area. Patient demographics, vital signs, laboratory results were extracted from our institutional COVID-19 Data Warehouse. Following the convention of qCSI variables, respiratory rate (breaths/min), pulse oximetry (%), and oxygen flow rate (L/ min) were used to calculate points between 0 to 12, with higher points associated with highly likelihood of respiratory decompensation within 24 hours.Results: 35,696 COVID-19 patients were admitted via the emergency department during the study period. The mean qCSI was 1.73 (SD 1.82) for non-ICU admissions (n¼34,647). The mean qCSI was 2.83 (SD 2.53) for ICU admission (n¼1,049). As of the time of submission, ED treat and release patients, as well as decompensation results are pending.Conclusions: In this validation study of qCSI using a large system cohort of COVID-19 patients, qCSI appears to correlate strongly with clinical triage for admission decision to regular floor vs. ICU level care. Further analysis is needed to identify 24-hour respiratory decompensation after regular floor admission.

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