Proposal of COVID-19 Clinical Risk Score for the management of suspected COVID-19 cases: a case control study

Abstract

Background No clinical scoring system has yet been established to estimate the likelihood of coronavirus disease (COVID-19) and determine the suitability of diagnostic testing in suspected COVID-19 patients. Methods This was a single-center, retrospective, observational study of patients with suspected COVID-19 and confirmed COVID-19. Patient background, clinical course, laboratory and computed tomography (CT) findings, and the presence of alternative diagnoses were evaluated. Clinical risk scores were developed based on clinical differences between patients with and without COVID-19. Results Among 110 patients suspected of having COVID-19, 60.9% underwent polymerase chain reaction (PCR) testing based on the judgment of physicians. Two patients were found to have COVID-19. The clinical characteristics of 108 non-COVID-19 patients were compared with those of 23 confirmed COVID-19 patients. Patients with COVID-19 were more likely to have a history of high-risk exposures and an abnormal sense of taste and smell. The COVID-19 group had significantly higher rates of subnormal white blood cell counts, lower eosinophil counts, and lower procalcitonin levels than the non-COVID-19 group. When blood test results, CT findings, and the presence of alternative diagnoses were scored on an 11-point scale (i.e., “COVID-19 Clinical Risk Score”), the COVID-19 group scored significantly higher than the non-COVID-19 group, more than four points in the COVID-19 group. All non-COVID patients who did not undergo PCR had a score of 4 or less. Conclusions The COVID-19 Clinical Risk Score may enable the risk classification of patients suspected of having COVID-19 and can help in decision-making in clinical practice, including appropriateness of diagnostic testing. Further studies and prospective validation with an increased sample size are required.

Clinical outcome, risk assessment, and seasonal variation in hospitalized COVID-19 patients—Results from the CORONA Germany study

“…Hence, we overcome some limitations of other published risk scores with retrospective analysis or smaller sample sizes [ 15 ]. In contrast to the approach of Nakakubo et al who included diagnostic imaging to the risk score [ 16 ], we focused on simple baseline characteristics and laboratory values, accessible for general practitioners or clinicians in emergency departments. Especially in the current pandemic situation with further rising infection rates worldwide, it is necessary to detect vulnerable patients fast and easily.…”

Fukuchi-Manabe Score for Infection Control Measures During the Very Early COVID-19 Pandemic Period When Access to Reverse Transcription-Polymerase Chain Reaction Testing Was Poor in Japan: A Single-Center Observational Prospective Cohort Study

“…At least 100 million cases and 3 million deaths were confirmed in the first half of 2020 [ 1 , 2 ]. Although there has been extensive research regarding the pathogenesis, epidemiology, management, prevention, complications, and treatment of COVID-19 [ 3 , 4 ], there is little evidence regarding the diagnosis and quarantine of possible patients with COVID-19 [ 5 , 6 ]. This was particularly relevant in the early pandemic stage when access to reverse transcription-polymerase chain reaction (RT-PCR) testing was limited.…”