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

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)

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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dc.contributor.author: 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)
dc.date.accessioned: 2025-01-28T21:03:09Z
dc.date.available: 2025-01-28T21:03:09Z
dc.date.issued: 2022-12
dc.description.abstract - en: 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.
dc.description.sponsorship: 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.
dc.identifier.doi: https://doi.org/10.1002/emp2.12868
dc.identifier.issn: 2688-1152
dc.identifier.pubmedID: 36579029
dc.identifier.uri: https://open-science.canada.ca/handle/123456789/3372
dc.language.iso: en
dc.publisher - en: Wiley Periodicals LLC on behalf of American College of Emergency Physicians
dc.rights - en: Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)
dc.rights - fr: Creative Commons Attribution - Pas d'utilisation commerciale - Pas de modification 4.0 International (CC BY-NC-ND 4.0)
dc.rights.uri - en: https://creativecommons.org/licenses/by-nc-nd/4.0/
dc.rights.uri - fr: https://creativecommons.org/licenses/by-nc-nd/4.0/deed.fr
dc.subject - en: Health; Coronavirus diseases; Decision making; Models
dc.subject - fr: Santé; Maladie à coronavirus; Prise de décision; Modèle
dc.subject.en - en: Health; Coronavirus diseases; Decision making; Models
dc.subject.fr - fr: Santé; Maladie à coronavirus; Prise de décision; Modèle
dc.title - en: Derivation and validation of a clinical decision rule to risk‐stratify COVID‐19 patients discharged from the emergency department : the CCEDRRN COVID discharge score
dc.type - en: Article
dc.type - fr: Article
local.acceptedmanuscript.articlenum: e12868
local.article.journalissue: 6
local.article.journaltitle - en: JACEP Open
local.article.journalvolume: 3
local.pagination: 1-11
local.peerreview - en: Yes
local.peerreview - fr: Oui