Early prognostication of COVID-19 to guide hospitalisation versus outpatient monitoring using a point-of-test risk prediction score

Felix Chua,Matthew Knight,Chhaya Popat,Shershah Assadullah,Harry Mitchell,Radhika Kumar,Jaswinder Singh,Aisling O’neill ,Mkh Leung ,Lisa Spencer ,Miriam Schechter,Rebecca Talbutt,Tejal Vaghela,Noor Mahdi,Philip L Molyneaux ,Rahul Mogal,Rama Vancheeswaran,Thomas J Humphries ,Adrian Draper,Sam Calmonson,Erica Thwaite,Jeremy Lowe,Sarika Raghunath,Andrew Barlow

doi:10.1136/thoraxjnl-2020-216425

Abstract

IntroductionRisk factors of adverse outcomes in COVID-19 are defined but stratification of mortality using non-laboratory measured scores, particularly at the time of prehospital SARS-CoV-2 testing, is lacking.MethodsMultivariate regression with bootstrapping...

Highlights

Risk factors of adverse outcomes in COVID-19 are defined but stratification of mortality using non-laboratory measured scores, at the time of prehospital SARS-CoV-2 testing, is lacking
The median age of the cohort was 70 (IQR 53–83; range 23–99); median age was lowest in the virtual hospital pathway (53; IQR 43–67) and highest among hospitalised patients who did not receive continuous positive airway pressure (CPAP) (77; IQR 61–86) (p
Obesity, defined as body mass index (BMI)>30, was present in 24.7% (243) of the cohort and is associated with an unadjusted OR for death of 1.40

Summary

Introduction

Risk factors of adverse outcomes in COVID-19 are defined but stratification of mortality using non-laboratory measured scores, at the time of prehospital SARS-CoV-2 testing, is lacking. Its predictive accuracy (calibration) in both external cohorts was consistently higher in patients with milder disease (SOARS 0–1), the same individuals who could be identified for safe outpatient monitoring. Conclusion The SOARS score uses constitutive and readily assessed individual characteristics to predict the risk of COVID-19 death. Deployment of the score could potentially inform clinical triage in preadmission settings where expedient and reliable decision-making is key. ►► A five-predictor risk prediction score (SOARS) based on demographic and clinical characteristics can quickly and reliably identify COVID-19-positive patients who have a low probability of mortality for outpatient monitoring and management. The availability of a practical prehospital predictive tool to triage patients for safe discharge to an outpatient (virtual) monitoring system versus direct

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