Development and Validation of the Acute PNeumonia Early Assessment Score for Safely Discharging Low-Risk SARS-CoV-2-Infected Patients from the Emergency Department

Abstract

A continuous demand for assistance and an overcrowded emergency department (ED) require early and safe discharge of low-risk severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients. We developed (n = 128) and validated (n = 330) the acute PNeumonia early assessment (aPNea) score in a tertiary hospital and preliminarily tested the score on an external secondary hospital (n = 97). The score’s performance was compared to that of the National Early Warning Score 2 (NEWS2). The composite outcome of either death or oral intubation within 30 days from admission occurred in 101 and 28 patients in the two hospitals, respectively. The area under the receiver operating characteristic (AUROC) curve of the aPNea model was 0.86 (95% confidence interval (CI), 0.78–0.93) and 0.79 (95% CI, 0.73–0.89) for the development and validation cohorts, respectively. The aPNea score discriminated low-risk patients better than NEWS2 at a 10% outcome probability, corresponding to five cut-off points and one cut-off point, respectively. aPNea’s cut-off reduced the number of unnecessary hospitalizations without missing outcomes by 27% (95% CI, 9–41) in the validation cohort. NEWS2 was not significant. In the external cohort, aPNea’s cut-off had 93% sensitivity (95% CI, 83–102) and a 94% negative predictive value (95% CI, 87–102). In conclusion, the aPNea score appears to be appropriate for discharging low-risk SARS-CoV-2-infected patients from the ED.

Home management of COVID-19 symptomatic patients: a safety study on COVID committed home medical teams

“…This strategy could permit that, with an easily feasible and low-cost test, it is possible to determine the severity and the risk class to which the patient belongs, at least in terms of screening, to direct the patient to the hospital [15]. As some studies have suggested, widespread SpO2 self-monitoring at home (at rest and after walking test) in non-severe COVID-19 could be crucial, reserving anothers testing (blood count, CPR, DDimer, chest X-ray or TC scan) to a more severe disease stage [16,17].…”

After SARS-CoV-2 Pandemics: New Insights into ICU-Acquired Pneumonia

“…Early and safe discharge of low-risk severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients is one of the important elements to analyze. A previously defined physiologic score, called aPNea, composed of the alveolar to arterial oxygen (A–A O 2 ) gradient, silent hypoxia diagnosed after a positive 6 min walk test, the importance of lung imaging abnormalities, and the importance of proinflammatory reactions (fever, elevated plasma D-dimer level) compared favorably with traditional severity scores such as NEWS2 (AUC-ROC 0.86 (95% confidence interval (CI), 0.78–0.93)) in predicting a safe hospital discharge from the ED [ 3 ]. Further multicenter validation of the aPNea score in Italy and other countries is needed.…”