ABSTRACT
Objectives. To develop and validate a triage scale (Spanish acronym, TIHCOVID) to assign priority by predicting critical events in patients with severe COVID-19 who are candidates for interhospital transfer. Methods. Prospective cohort study in 2 periods for internal (February-April 2020) and external (October-December 2020) validation. We included consecutive patients with severe COVID-19 who were transported by the emergency medical service of Catalonia. A risk model was developed to predict mortality based on variables recorded on first contact between the regional emergency coordination center and the transferring hospital. The model's performance was evaluated by means of calibration and discrimination, and the results for the first and second periods were compared. Results. Nine hundred patients were included, 450 in each period. In-hospital mortality was 33.8%. The 7 predictors included in the final model were age, comorbidity, need for prone positioning, renal insufficiency, use of high-flow nasal oxygen prior to mechanical ventilation, and a ratio of PaO2 to inspired oxygen fraction of less than 50. The performance of the model was good (Brier score, 0.172), and calibration and discrimination were consistent. We found no significant differences between the internal and external validation steps with respect to either the calibration slopes (0.92 [95% CI, 0.91-0.93] vs 1.12 [95% CI, 0.6-1.17], respectively;P = .150) or discrimination (area under the curve, 0.81 [95% CI, 0.75-0.84] vs 0.85 [95% CI, 0.81-0.89];P = .121). Conclusion. The TIHCOVID tool may be useful for triage when assigning priority for patients with severe COVID-19 who require transfer between hospitals. Objetivo. Desarrollar y validar una escala predictiva de eventos críticos en pacientes con infección grave por COVID-19 candidatos a traslado interhospitalario (TIH) que facilite el triaje y la priorización del transporte sanitario. Método. Estudio de cohortes prospectivo divido en dos periodos: validación interna (febrero-abril 2020) y validación externa (octubre-diciembre 2020). Se incluyeron consecutivamente los pacientes con infección grave por COVID-19 trasladados por el Sistema de Emergencias Médicas de Cataluña. Se construyó un modelo predictivo de las variables asociadas a la mortalidad recogidas en el momento del primer contacto entre el hospital emisor y el centro de coordinación. Se calculó el rendimiento del modelo y se comparó la validación interna y externa, evaluando la calibración y la discriminación. Resultados. Se incluyeron 900 pacientes, 450 pacientes en cada periodo de estudio. La mortalidad durante el ingreso fue del 33,8%. Las 7 variables predictoras incluidas en el modelo final fueron edad, comorbilidad, pronación, insufi- ciencia renal aguda, uso de oxigenoterapia de alto flujo previa a la ventilación mecánica invasiva, tabaquismo activo y un valor de PaO2/FiO2 < 50. El modelo mostró un buen rendimiento (Brier = 0,172) y consistencia en la calibración y discriminación. No se objetivaron diferencias en la pendiente de calibración [0,92 (IC 95%: 0,91-0,93) vs 1,12 (IC 95%: 0,6-1,17);p = 0,150] ni en la capacidad discriminativa [ABC 0,81 (IC 95%: 0,75-0,84) vs ABC de 0,85 (IC 95%: 0,81-0,89), p = 0,121] entre la validación interna y externa. Conclusiones. La escala TIHCOVID puede ser de ayuda para el triaje de pacientes con infección COVID-19 grave que precisan traslado interhospitalario.
ABSTRACT
BACKGROUND: The extraordinary situation caused by the onset of COVID-19 has meant that at prehospital level, the number of treatments, profile and time taken to respond for treating time-dependent pathologies has been greatly affected. However, it is not known whether the prehospital profile of polytrauma patients (PTP) has been affected. OBJECTIVE: To determine differences in the epidemiological characteristics and the clinical variables of prehospital polytrauma patients during the first wave of the COVID-19 pandemic in Catalonia. METHODOLOGY: Analytical cross-sectional study. The number of prehospital activations and the clinical and epidemiological characteristics of polytrauma patients attended by the Emergency Medical System (EMS) of Catalonia, were compared for the period between 15 February and 15 May 2020 and the same period in the previous year. Priorities 0 and 1 are assigned to the most severely injured patients. An analysis was conducted using logistic regression and nonparametric tests. RESULTS: 3023 patients were included. During the 2019 study period, 2045 (67.6%) patients were treated; however, during the pandemic period, 978 (32.4%) patients were treated, representing a 52% decrease (p = 0.002). The percentage of patients presenting priority 1 was higher during the pandemic period [240 (11.7%) vs 146 (14.9%), p = 0.032]. The percentage of priority 0 and 1 patients attended by a basic life support unit increased [201 (9.8%) vs 133 (13.6%), p = 0.006]. The number of traffic accidents decreased from 1211 (59.2%) to 522 (53.4%) and pedestrian-vehicle collisions fell from 249 (12.2%) to 92 (9.4%). Regarding weapon-related injuries and burns, there was an increase in the number of cases [43 (2.1%) vs 41 (4.2%), and 15 (0.7%) vs 22 (2.2%), p = 0.002 and p < 0.001, respectively]. Hospital mortality remained unchanged (3.9%). CONCLUSIONS: During the first wave of the pandemic, the number of polytrauma patients decreased and there was a change in the profile of severity and type of accident.