Risk Stratification of COVID-19 Patients based on Proposed Simple Clinical Parameters Score: A Retrospective Observational Study

Abstract

Introduction: India has impacted severely by multiple waves of Coronavirus Disease-2019 (COVID-19) and still struggling with limitation of resources to cater such a huge population. Available triage methods to treat COVID-19 are either too complex to use or time-consuming. A triage score, that should be independent of any laboratory investigations and exclusively based on clinical parameters was required, so that the healthcare provider at the first contact can segregate patients on the basis of intensity of care required to save, as many lives as, possible. Simple Clinical Parameters (SCIP) score may be a useful tool for fast triage of patients at the point of care and can help to screen patients, who will benefit from early hospitalisation, from those, who can be managed as outpatients. Aim: To validate the usefulness of SCIP score in triage of COVID-19. Materials and Methods: This single-centre, retrospective, observational study was conducted at a Tertiary Care Hospital. The duration of the study was six months, from Nov 2021 to May 2022. A total of 945 patients were involved in the present study. SCIP score was formulated using basic clinical parameters like Pulse Rate (PR), Respiratory Rate (RR), and arterial oxygen saturation at room air (SpO2 ). The risk score ranges from 1 to 10. The lower the score, more severe the disease and hence, more intense care is warranted. All the parameters required for calculating the SCIP score are continuous variables, expressed in mean±Standard Deviation (SD) and categorical data of patients in specific levels of care are represented as proportions. Data was collected and analysed using Microsoft Excel 2007 and the Python statistics module. Results: The mean age of the study participants was 49.7±16.5 years. A total 945 patients were included in the study, out of which 552 (58.4%) were males and 393 (41.6%) were females. In more than half patients, the LOC predicted by the proposed SCIP score, matched the actual Level of Care (LOC) received. The mean scores were within the proposed score ranges. SCIP score was 97% sensitive in detecting the patients, who can be managed at Outpatient Department (OPD) and 99% specific in detecting those, who did not require intensive treatment at Intensive Care Unit (ICU). SCIP score showed the need for ICU with 92% accuracy and the patients, who can be treated at OPD, without requiring hospitalisation with 90% accuracy. Conclusion: SCIP scoring system based on routine clinical parameters, is helpful in early detection of severity of the disease and in making a fast decision to predict the LOC required. A score based on clinical parameters ensures the availability of a fast and simple triage method to ensure optimal utilisation of available resources and help healthcare provider to make quick decisions.