ABSTRACT
BACKGROUND: Identifying which patients with COVID-19 have a high risk of severe illness is essential to optimizing management and resource utilization strategies. OBJECTIVES: The aim of this study was to externally validate the diagnostic utility of the Covichem score for predicting COVID-19 disease severity, and secondarily to evaluate its utility in predicting intensive care unit (ICU) admission, and in-hospital mortality. METHODS: All consecutive COVID-19 patients who presented to the emergency department (ED) were included, and patients' demographic data, comorbidities, vital signs, oxygen requirement, and laboratory results were recorded. We calculated patients' Covichem scores and estimates (using a threshold of 0.5) and evaluated the utility of the Covichem score for predicting disease severity, ICU admission, and mortality. RESULTS: The median Covichem score was significantly higher for patients with severe illness (Covichem score: 0.170, IQR: 0.298, n = 300 vs. Covichem score: 0.026, IQR: 0.065, n: 191; p < 0.001). Based on their Covichem scores, 12.4% (61/491) of the patients were predicted to experience severe illness (threshold: 0.5), the accuracy of the Covichem score was poor, as the area under curve (AUC) was 48.5% (18.1% sensitivity and 93.8% specificity). When we calculated a new ideal threshold, the AUC reached 82%, but the sensitivity was 79.9% and the specificity was 71.2%. CONCLUSION: In this external validation of the Covichem score, we found that it performed worse than in the original derivation and validation study, even with the assistance of a new cutoff.
Subject(s)
COVID-19 , COVID-19/diagnosis , COVID-19 Testing , Emergency Service, Hospital , Hospital Mortality , Humans , Intensive Care Units , Oxygen , Prognosis , ROC Curve , Retrospective StudiesABSTRACT
BACKGROUND: International COVID-19 guidelines recommend that health care workers (HCWs) wear filtering facepiece (FFP) respirators to reduce exposure risk. However, there are concerns about FFP respirators causing hypercapnia via rebreathing carbon dioxide (CO2). Most previous studies measured the physiological effects of FFP respirators on treadmills or while resting, and such measurements may not reflect the physiological changes of HCWs working in the emergency department (ED). OBJECTIVE: Our aim was to evaluate the physiological and clinical impacts of FFP type II (FFP2) respirators on HCWs during 2 h of their day shift in the ED. METHODS: We included emergency HCWs in this prospective cohort study. We measured end-tidal CO2 (ETCO2), mean arterial pressure (MAP), respiratory rate (RR), and heart rate values and dyspnea scores of subjects at two time points. The first measurements were carried out with medical masks while resting. Subjects then began their day shift in the ED with medical mask plus FFP2 respirator. We called subjects after 2 h for the second measurement. RESULTS: The median age of 153 healthy volunteers was 24.0 years (interquartile range 24.0-25.0 years). Subjects' MAP, RR, and ETCO2 values and dyspnea scores were significantly higher after 2 h. Median ETCO2 values increased from 36.4 to 38.8 mm Hg. None of the subjects had hypercapnia symptoms, hypoxia, or other adverse effects. CONCLUSION: We did not observe any clinical reflection of these changes in physiological values. Thus, we evaluated these changes to be clinically insignificant. We found that it is safe for healthy HCWs to wear medical masks plus FFP2 respirators during a 2-h working shift in the ED.