Development and Validation of the Acute PNeumonia Early Assessment Score for Safely Discharging Low-Risk SARS-CoV-2-Infected Patients from the Emergency Department.

Daniele Orso,Sara Fossati,Maurizio Tonizzo,GianLuca Colussi,Elisa Pontoni,Domenico Arcidiacono,Francesco Cugini,Silvia Da Ros,Massimo Crapis,Walter Mancini,Alessandro Grembiale,Astrid Callegari,Laura De Santi,Rossella Carnelos,Sergio Venturini

doi:10.3390/jcm11030881

Abstract

A continuous demand for assistance and an overcrowded emergency department (ED) require early and safe discharge of low-risk severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients. We developed (n = 128) and validated (n = 330) the acute PNeumonia early assessment (aPNea) score in a tertiary hospital and preliminarily tested the score on an external secondary hospital (n = 97). The score’s performance was compared to that of the National Early Warning Score 2 (NEWS2). The composite outcome of either death or oral intubation within 30 days from admission occurred in 101 and 28 patients in the two hospitals, respectively. The area under the receiver operating characteristic (AUROC) curve of the aPNea model was 0.86 (95% confidence interval (CI), 0.78–0.93) and 0.79 (95% CI, 0.73–0.89) for the development and validation cohorts, respectively. The aPNea score discriminated low-risk patients better than NEWS2 at a 10% outcome probability, corresponding to five cut-off points and one cut-off point, respectively. aPNea’s cut-off reduced the number of unnecessary hospitalizations without missing outcomes by 27% (95% CI, 9–41) in the validation cohort. NEWS2 was not significant. In the external cohort, aPNea’s cut-off had 93% sensitivity (95% CI, 83–102) and a 94% negative predictive value (95% CI, 87–102). In conclusion, the aPNea score appears to be appropriate for discharging low-risk SARS-CoV-2-infected patients from the ED.

Highlights

An insidious type of pneumonia caused by a new coronavirus infection appeared at the end of 2019 in Wuhan, China, and soon became a pandemic disease
We present the results of the acute PNeumonia early assessment (aPNea) score’s performance and metrics compared with those of the National Early Warning Score 2 (NEWS2) calculated on the same cohorts
The viral RNA was analyzed by a reverse transcriptase-polymerase chain reaction (RT-PCR) and COVID-19 was diagnosed according to the World Health Organization (WHO)’s guidance [7]

Summary

Introduction

An insidious type of pneumonia caused by a new coronavirus infection appeared at the end of 2019 in Wuhan, China, and soon became a pandemic disease. The rapid overload of medical wards and intensive care units (ICUs) with SARS-CoV-2-infected patients quickly saturated hospitals’ capacity, with important consequences for the global survival of the Italian population [3]. The emergency department (ED) has been the first point-of-care at which patients with respiratory symptoms and suspicion of SARS-CoV-2 infection present for assistance. Discrimination of the low-risk patient to discharge early and safely at home is fundamental for reducing ED overcrowding. This discrimination should be performed by objective criteria based on clinical conditions, vital signs, and other significant prognostic factors that should help the clinician determine the probability of sudden adverse events or serious clinical progression

Methods

Results

Conclusion