Clinical stability and in-hospital mortality prediction in COVID-19 patients presenting to the Emergency Department

Abstract

BacKGrOUnd: The novara-cOvid score was developed to help the emergency physician to decide which coronavirus disease (cOvid) patient required hospitalization at emergency department (ed) presentation and to which intensity of care. We aimed at evaluating its prognostic role. MeTHOdS: We retrospectively collected data of cOvid patients admitted to our ed between March 16 and april 22, 2020. The novara-cOvid score was systematically applied to all cOvid patients since its introduction in clinical practice and adopted to decide patients' destination. The ability of the novara-cOvid score to predict in-hospital clinical stability and in-hospital mortality were evaluated through multivariable logistic regression and cox regression hazard models, respectively. reSULTS: among the 480 cOvid patients admitted to the ed, 338 were hospitalized: the novara-cOvid score was 0-1 in 49.7%, 2 in 24.6%, 3 in 15.4% and 4-5 in 10.3% of patients. novara-cOvid score values of 3 and 4-5 were associated with lower clinical stability with adjusted odds ratios of 0.28 (0.13-0.59) and 0.03 (0.01-0.12), respectively. When inhospital mortality was evaluated, a significant difference emerged between scores of 0-1 and 2 vs. 3 and 4-5. in particular, the death adjusted hazard ratio for novara-cOvid scores of 3 and 4-5 were 2.6 (1.4-4.8) and 8.4 (4.7-15.2), respectively. cOncLUSiOnS: The novara-cOvid score reliably predicts in-hospital clinical instability and mortality of cOvid patients at ed presentation. This tool allows the emergency physician to detect patients at higher risk of clinical deterioration, suggesting a more aggressive therapeutic management from the beginning.

Systems for recognition and response to deteriorating emergency department patients: a scoping review

“…Thirty-two studies were single site studies [ 19 , 20 , 32 – 41 , 43 – 62 ]. The countries of origin were Turkey ( n = 8) [ 33 , 34 , 37 – 39 , 42 , 45 , 48 ], United States ( n = 3) [ 41 , 43 , 49 ], United Kingdom ( n = 3) [ 44 , 50 , 51 ], Australia ( n = 3) [ 19 , 20 , 57 ], China ( n = 3) [ 35 , 60 , 62 ], Italy ( n = 2) [ 58 , 61 ], Indonesia ( n = 2) [ 46 , 47 ] and one study each from Finland [ 32 ], Demark [ 54 ], Norway [ 36 ], Netherlands [ 40 ]. Switzerland [ 55 ], Brazil [ 52 ], Singapore [ 53 ], Taiwan [ 59 ], and Korea [ 56 ].…”

“…Thirty-two studies were single site studies [19,20,[32][33][34][35][36][37][38][39][40][41][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62]. The countries of origin were Turkey (n = 8) [33, 34, 37-39, 42, 45, 48], United States (n = 3) [41,43,49], United Kingdom (n = 3) [44,50,51], Australia (n = 3) [19,20,57], China (n = 3) [35,60,62], Italy (n = 2) [58,61], Indonesia (n = 2) [46,47] and one study each from Finland [32], De...…”

“…Only six studies explicitly reported the response to ED patients identified as deteriorating [19,20,44,49,52,58].…”

“…The majority of studies of aggregate scoring systems showed that patients who died had higher scores than those who survived and this was the case for MEWS [34,35,37,39,42,45,48,53], NEWS [32,36,40,56,61], NEWS2 [61], NEWS-C [61], qSOFA [33,61], REMS [42,61], GAP [39], BEWS [54], RTS [60] and Novara-COVID scores [58]. One study showed that MEWS progression (increasing scores) was associated with significantly higher 7-and 30-day mortality [59].…”

“…• Hospital admission vs discharge from ED (n = 9) [35-38, 40-42, 45, 48, 51] • Hospital admission vs died in ED (n = 2) [37,42] • Hospital admission vs ICU admission (n = 2) [37,42] Clinical stability (n = 3) Significantly lower levels of clinical stability occurred in patients with Novara-COVID scores of 3 (OR = 0.28, 95%CI 0.13-0.59) or 4-5 (OR = 0.03, 95%CI 0.006-0.12) [58].…”