Derivation and validation of a clinical decision rule to risk‐stratify COVID‐19 patients discharged from the emergency department : the CCEDRRN COVID discharge score

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DOI

https://doi.org/10.1002/emp2.12868

Language of the publication
English
Date
2022-12
Type
Article
Author(s)
  • Brooks, Steven C.
  • Rosychuk, Rhonda J.
  • Perry, Jeffrey J.
  • Morrison, Laurie J.
  • Wiemer, Hana
  • Fok, Patrick
  • Rowe, Brian H.
  • Daoust, Raoul
  • Vatanpour, Shabnam
  • Turner, Joel
  • Landes, Megan
  • Ohle, Robert
  • Hayward, Jake
  • Scheuermeyer, Frank
  • Welsford, Michelle
  • Hohl, Corinne
  • the Canadian COVID-19 Rapid Response Network (CCEDRRN) for the Network of Canadian Emergency Researchers (NCER) and the Canadian Critical Care Trials Group (CCCTG)
Publisher
Wiley Periodicals LLC on behalf of American College of Emergency Physicians

Abstract

Objective
To risk‐stratify COVID‐19 patients being considered for discharge from the emergency department (ED).

Methods
We conducted an observational study to derive and validate a clinical decision rule to identify COVID‐19 patients at risk for hospital admission or death within 72 hours of ED discharge. We used data from 49 sites in the Canadian COVID‐19 Emergency Department Rapid Response Network (CCEDRRN) between March 1, 2020, and September 8, 2021. We randomly assigned hospitals to derivation or validation and prespecified clinical variables as candidate predictors. We used logistic regression to develop the score in a derivation cohort and examined its performance in predicting short‐term adverse outcomes in a validation cohort.

Results
Of 15,305 eligible patient visits, 535 (3.6%) experienced the outcome. The score included age, sex, pregnancy status, temperature, arrival mode, respiratory rate, and respiratory distress. The area under the curve was 0.70 (95% confidence interval [CI] 0.68–0.73) in derivation and 0.71 (95% CI 0.68–0.73) in combined derivation and validation cohorts. Among those with a score of 3 or less, the risk for the primary outcome was 1.9% or less, and the sensitivity of using 3 as a rule‐out score was 89.3% (95% CI 82.7–94.0). Among those with a score of ≥9, the risk for the primary outcome was as high as 12.2% and the specificity of using 9 as a rule‐in score was 95.6% (95% CI 94.9–96.2).

Conclusion
The CCEDRRN COVID discharge score can identify patients at risk of short‐term adverse outcomes after ED discharge with variables that are readily available on patient arrival.

Subject

  • Health,
  • Coronavirus diseases,
  • Decision making,
  • Models

Rights

Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)

Pagination

1-11

Peer review

Yes

Identifiers

PubMed ID
36579029
ISSN
2688-1152

Article

Journal title
JACEP Open
Journal volume
3
Journal issue
6
Article number
e12868

Sponsors

The Canadian Institutes of Health Research (447679), Ontario Ministry of Colleges and Universities (C‐655‐2129), Saskatchewan Health Research Foundation (5357), Genome BC (COV024 and VAC007), Foundation du CHU de Québec (Octroi No. 4007), Sero‐Surveillance and Research (COVID‐19 Immunity Task Force Initiative), and Public Health Agency of Canada provided peer‐reviewed funding. The BC Academic Health Science Network and BioTalent Canada provided non‐peer reviewed funding.

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Communicable diseases

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