ABSTRACT
Background: To develop and validate an early-warning model to predict in-hospital mortality on admission of COVID-19 patients at an emergency department (ED).Methods: In total, 2782 patients were enrolled between March 2020 and December 2020, including 2106 patients (first wave) and 676 patients (second wave) in the COVID-19 outbreak in Italy. The firstwave patients were divided into two groups with 1474 patients used to train the model, and 632 to validate it. The 676 patients in the second wave were used to test the model. Age, 17 blood analytes and Brescia chest X-ray score were the variables processed using a Random Forests classification algorithm to build and validate the model. ROC analysis was used to assess the model performances. A web-based death-risk calculator was implemented and integrated within the Laboratory Information System of the hospital.Results: The final score was constructed by age (the most powerful predictor), blood analytes (the strongest predictors were lactate dehydrogenase, D-dimer, Neutrophil/Lymphocyte ratio, C-reactive protein, Lymphocyte %, Ferritin std and Monocyte %), and Brescia chest X-ray score. The areas under the receiver operating characteristic curve obtained for the three groups (training, validating and testing) were 0.98, 0.83 and 0.78, respectively.Conclusions: The model predicts in-hospital mortality on the basis of data that can be obtained in a short time, directly at the ED on admission. It functions as a web-based calculator, providing a risk score which is easy to interpret. It can be used in the triage process to support the decision on patient allocation.
ABSTRACT
To evaluate the performance of a clinical-radiological index (RAPID-Covid score) in achieving Safe Discharge (SD) of patients accessing the Emergency Department (ED) with symptoms suggesting Covid-19. Clinical and radiological data were retrospectively collected from 853 consecutive patients admitted to the ED during the pandemics with symptoms suggesting Covid-19. Illness severity was graded with RAPID-Covid score, composed of chest X-ray findings, clinical symptoms and PaO2/FiO(2). Patients with RAPID-Covid score >= 5 were admitted. Primary outcome was SD of patients to home care. SD was defined as survival of the patient, without evidence of second access to ED requiring hospitalization. 212/853 patients were discharged. 27/212 had a score >= 5 but refused admission. 185/212 were discharged with score <5: 147/185 (79,5%) survived and did not re-access ED;1/185 (0,5%) died at home after first ED-dismissal;37/185 (20,0%) had a second access. Of these 15/37 (8,1%) were newly dismissed and one of them (1/15) died at home;22/37 (11,9%) were hospitalized, 1/22 died during hospitalization. SD was obtained in 161/185 patients (87%). Readmissions occurred 5,1 +/- 2,6days from first discharge. Follow-up was 16,7 +/- 6,0days. RAPID-Covid score proves useful for SD of Covid-19 to home care. 6-10days may further increase confidence.