The challenge of deciding between home-discharge versus hospitalization in COVID-19 patients: The role of initial imaging and clinicolaboratory data

Abstract

Background/Objective It is important to predict the COVID-19 patient's prognosis, particularly in countries with lack or deficiency of medical resource for patient's triage management. Currently, WHO guideline suggests using chest imaging in addition to clinicolaboratory evaluation to decide on triage between home-discharge versus hospitalization. We designed our study to validate this recommendation to guide clinicians. This study providing some suggestions to guide clinicians for better decision making in 2020. Methods In this retrospective study, patients with RT-PCR confirmed COVID-19 (N = 213) were divided in different clinical and management scenarios: home-discharge, ward hospitalization and ICU admission. We reviewed the patient's initial chest CT if available. We evaluated quantitative and qualitative characteristics of CT as well as relevant available clinicolaboratory data. Chi-square, One-Way ANOVA and Paired t -test were used for analysis. Results The finding showed that most patients with mixed patterns, pleural effusion, 5 lobes involved, total score ≥10, SpO2% ≤ 90, ESR (mm/h) ≥ 60 and WBC (10 3 /μL) ≥ 8000 were hospitalized. Most patients with Ground-glass opacities only, ≤3 lobes involvement, peripheral distribution, SpO2% ≥ 95, ESR (mm/h) < 30 and WBC(10 3 /μL) < 6000 were home-discharged. Conclusions This study suggests the use of initial chest CT (qualitative and quantitative evaluation) in addition to initial clinicolaboratory data could be a useful supplementary method for clinical management and it is an excellent decision making tool (home-discharge versus ICU/Ward admission) for clinicians.

COVID-19 Vaccines Cost-Effectiveness Analysis: A Scenario for Iran

“…In the absence of any COVID-19 vaccine in Iran (population, 79,926,270), the infection rate was 17.6 per 1000 (1,411,731 cases), and about 57,889 deaths were reported [3]. The average hospitalization and ICU admission rates were 42.2% and 15%, respectively [58].…”

Triaging of COVID-19 patients using low dose chest CT: Incidence and factor analysis of lung involvement on CT images

“…Although there were increasing positive evidences of CT to evaluate COVID-19 patients [ 3 , 7 , 22 , 23 ], it is not realistic way to perform CT scans for all huge COVID-19 patients in a pandemic. Radiation exposure of CT may be problematic even when using low dose in especially young patients.…”

“…Therefore, the quantitative assessment based on CT scan is required for the triaging of COVID-19 patients. A CT severity score was firstly reported by Pan et al [ 8 ] and it was subsequently used for disease classification and severity prediction [ 3 , 7 , 10 ]. Mozafari et al [ 3 ] suggested that CT scores <10 and ≧ 10 were indicators for home-discharge and hospitalization, respectively.…”

“…A CT severity score was firstly reported by Pan et al [ 8 ] and it was subsequently used for disease classification and severity prediction [ 3 , 7 , 10 ]. Mozafari et al [ 3 ] suggested that CT scores <10 and ≧ 10 were indicators for home-discharge and hospitalization, respectively. According to Zhou et al [ 10 ], a CT score ≧ 16 was a risk factor for a poor prognosis and Francone et al [ 7 ] reported that a CT score >18 was more highly predictive of patient mortality in the course of short-term follow.…”

“…The pandemic and limited medical resources necessitated the triaging of patients with COVID-19 infection [ 3 ]. Although there were increasing positive evidences of CT scans to evaluate COVID-19 patients, further consideration for their indication in triage were required from the risk of radiation exposure and the capacity of CT scanning.…”