Fast track triage for COVID-19 based on a population study: the SODA score

Abstract

Abstract Background Healthcare systems are under prominent stress due to the COVID-19 pandemic. A fast and simple triage is mandatory to screen patients who will benefit from early hospitalization, from those that can be managed as outpatients. There is a lack of all-comers scores, and no score has been proposed for western-world population. Aims To develop a fast-track risk score valid for every COVID-19 patient at diagnosis. Methods Single-center, retrospective study based on all the inhabitants of a healthcare area. Logistic regression was used to identify simple and wide-available risk factors for adverse events (death, intensive care admission, invasive mechanical ventilation, bleeding >BARC3, acute renal injury, respiratory insufficiency, myocardial infarction, acute heart failure, pulmonary emboli, or stroke). Results Of the total healthcare area population, 447.979 inhabitants, 965 patients (0.22%), were diagnosed with COVID-19. A total of 124 patients (12.85%) experienced adverse events. The novel SODA score (based on sex, peripheral O2 saturation, presence of diabetes, and age) demonstrated good accuracy for adverse events prediction (area under ROC curve 0.858, CI: 0.82–0.98). A cut-off value of <2 points identifies patients with low risk (positive predictive value [PPV] for absence of events: 98.9%) and a cut-off of >5 points, high-risk patients (PPV 58.8% for adverse events). Conclusions This quick and easy score allows fast-track triage at the moment of diagnosis for COVID-19 using four simple variables: age, sex, SpO2, and diabetes. SODA score could improve preventive measures taken at diagnosis in high-risk patients and also relieve resources by identifying very low-risk patients. Funding Acknowledgement Type of funding sources: None. Figure 1. Receiver Operating Characteristic curve of SODA score to predict: A, adverse events (death, ICU admission, invasive mechanical ventilation, bleeding >BARC3, acute renal injury, respiratory insufficiency, myocardial infarction, acute heart failure, pulmonary emboli or stroke). Area under curve 0.858, CI: 0.82–0.98, p<0.001. B, mortality. Area under curve 0.89, CI: 0.58–0.94, p<0.001.Figure 2. Percentage of adverse events in each punctuation of the SODA score (green) and percentage of patients without adverse events (blue). Adverse events: death, ICU admission, invasive mechanical ventilation, bleeding >BARC3, acute renal injury, respiratory insufficiency, myocardial infarction, acute heart failure, pulmonary emboli, or stroke.