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1.
Am J Manag Care ; 29(12): e365-e371, 2023 Dec 01.
Article in English | MEDLINE | ID: mdl-38170527

ABSTRACT

OBJECTIVES: To develop a COVID-19-specific deterioration index for hospitalized patients: the COVID Hospitalized Patient Deterioration Index (COVID-HDI). This index builds on the proprietary Epic Deterioration Index, which was not developed for predicting respiratory deterioration events among patients with COVID-19. STUDY DESIGN: A retrospective observational cohort was used to develop and validate the COVID-HDI model to predict respiratory deterioration or death among hospitalized patients with COVID-19. Deterioration events were defined as death or requiring high-flow oxygen, bilevel positive airway pressure, mechanical ventilation, or intensive-level care within 72 hours of run time. The sample included hospitalized patients with COVID-19 diagnoses or positive tests at Kaiser Permanente Southern California between May 3, 2020, and October 17, 2020. METHODS: Machine learning models and 118 candidate predictors were used to generate benchmark performance. Logit regression with least absolute shrinkage and selection operator and physician input were used to finalize the model. Split-sample cross-validation was used to train and test the model. RESULTS: The area under the receiver operating curve was 0.83. COVID-HDI identifies patients at low risk (negative predictive value [NPV] > 98.5%) and borderline low risk (NPV > 95%) of an event. Of all patients, 74% were identified as being at low or borderline low risk at some point during their hospitalization and could be considered for discharge with or without home monitoring. A high-risk group with a positive predictive value of 51% included 12% of patients. Model performance remained high in a recent cohort of patients. CONCLUSIONS: COVID-HDI is a parsimonious, well-calibrated, and accurate model that may support clinical decision-making around discharge and escalation of care.


Subject(s)
COVID-19 , Humans , Critical Care , Hospitalization , Predictive Value of Tests , Retrospective Studies , SARS-CoV-2
2.
Perm J ; 19(3): e125-7, 2015.
Article in English | MEDLINE | ID: mdl-26176580

ABSTRACT

A previously healthy patient was seen in the Emergency Department for evaluation of a one-month history of cough and one-day history of hemoptysis. A computed tomography scan of the thorax found a mass on the right lower pulmonary lobe and a mass on the left upper lobe. A biopsy specimen of the right lobe lung mass, obtained during bronchoscopy, demonstrated papilloma. This case report, from a pulmonologist's perspective, includes a comprehensive review of the patient's clinical presentation and outcome, as well as a discussion of recurrent respiratory papillomatosis.


Subject(s)
Carcinoma, Squamous Cell/complications , Cough/etiology , Hemoptysis/etiology , Lung Neoplasms/complications , Papillomavirus Infections/complications , Respiratory Tract Infections/complications , Adult , Bronchoscopy , Carcinoma, Squamous Cell/diagnosis , Humans , Lung Neoplasms/diagnosis , Male , Papillomavirus Infections/diagnosis , Respiratory Tract Infections/diagnosis , Tomography, X-Ray Computed
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