COVID-19; clinical assessment; hospitalisations; risk management; Humans; SARS-CoV-2; Retrospective Studies; Hospitalization; Predictive Value of Tests; COVID-19/epidemiology; Emergency Medicine; Critical Care and Intensive Care Medicine
Abstract :
[en] [en] BACKGROUND: The HOME-CoV (Hospitalisation or Outpatient ManagEment of patients with SARS-CoV-2 infection) score is a validated list of uniquely clinical criteria indicating which patients with probable or proven COVID-19 can be treated at home. The aim of this study was to optimise the score to improve its ability to discriminate between patients who do and do not need admission.
METHODS: A revised HOME-CoV score was derived using data from a previous prospective multicentre study which evaluated the original Home-CoV score. Patients with proven or probable COVID-19 attending 34 EDs in France, Monaco and Belgium between April and May 2020 were included. The population was split into a derivation and validation sample corresponding to the observational and interventional phases of the original study. The main outcome was non-invasive or invasive ventilation or all-cause death within 7 days following inclusion. Two threshold values were defined using a sensitivity of >0.9 and a specificity of >0.9 to identify low-risk and high-risk patients, respectively. The revised HOME-CoV score was then validated by retrospectively applying it to patients in the same EDs with proven or probable COVID-19 during the interventional phase. The revised HOME-CoV score was also tested against original HOME-CoV, qCSI, qSOFA, CRB65 and SMART-COP in this validation cohort.
RESULTS: There were 1696 patients in the derivation cohort, of whom 65 (3.8%) required non-invasive ventilation or mechanical ventilation or died within 7 days and 1304 patients in the validation cohort, of whom 22 (1.7%) had a progression of illness. The revised score included seven clinical criteria. The area under the curve (AUC) was 87.6 (95% CI 84.7 to 90.6). The cut-offs to define low-risk and high-risk patients were <2 and >3, respectively. In the validation cohort, the AUC was 85.8 (95% CI 80.6 to 91.0). A score of <2 qualified 73% of patients as low risk with a sensitivity of 0.77 (0.55-0.92) and a negative predictive value of 0.99 (0.99-1.00).
CONCLUSION: The revised HOME-CoV score, which does not require laboratory testing, may allow accurate risk stratification and safely qualify a significant proportion of patients with probable or proven COVID-19 for home treatment.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Douillet, Delphine ; Emergency Department, CHU Angers, University of Angers, CHU Angers, Angers, France delphinedouillet@gmail.com ; UMR MitoVasc CNRS 6015 - INSERM 1083, Health Faculty, University of Angers, FCRIN, INNOVTE, Universite Angers Faculte des sciences, Angers, France
Riou, Jérémie; Micro et Nano médecines Translationnelles, MINT, UNIV Angers, UMR INSERM 1066, UMR CNRS 6021, CHU Angers, Angers, France ; Methodology and Biostatistics Department, Delegation to Clinical Research and Innovation, Angers University Hospital, Université Angers Faculté des Sciences, Angers, France
Morin, François ; Emergency Department, CHU Angers, University of Angers, CHU Angers, Angers, France
Mahieu, Rafaël; Department of Infectious Disease, Angers University Hospital, University of Angers, CHU Angers, Angers, France ; CRCINA, Inserm U1232, University of Nantes-Angers, Universite Angers Faculte Des Sciences, Angers, France
Chauvin, Anthony; Emergency Department, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Assistance Publique - Hopitaux de Paris, Paris, France
Gennai, Stéphane ; Emergency Department, Reims University Hospital, University Hospital Centre Reims, Reims, France ; UFR Médecine, Université de Reims Champagne-Ardenne, Reims, France
Ferrant, Lionel; Emergency Department, Université catholique de Louvain, Louvain-la-Neuve, Belgium
Sebbane, Mustapha ; Emergency Department, Montpellier University Hospital, Montpellier, France
Plantefeve, Gaëtan; Centre Hospitalier Victor Dupouy, Argenteuil, France
Brice, Christian; Emergency Department, Centre Hospitalier de Saint Brieuc, Saint Brieuc, France
Cayeux, Coralie; Emergency Department, Centre Hospitalier de Remiremont, Remiremont, France
Savary, Dominique ; Department of Emergency Medicine, University of Angers, ANGERS, France ; Inserm IRSET UMR_S1085, I, EHESP, Angers, France
Moumneh, Thomas; Emergency Department, CHU Angers, Angers, France
Penaloza, Andrea ; Emergency, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
Roy, Pierre Marie; Emergency Department, CHU Angers, University of Angers, CHU Angers, Angers, France ; UMR MitoVasc CNRS 6015 - INSERM 1083, Health Faculty, University of Angers, FCRIN, INNOVTE, Universite Angers Faculte des sciences, Angers, France
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