Identifying patients with symptoms suspicious for COVID-19 at elevated risk of adverse events: The COVAS score - 29/07/21

Doi : 10.1016/j.ajem.2020.10.068

Adam L. Sharp, MD, MSc ^a,^b,^c,^{^⁎} , Brian Z. Huang, PhD, MPH ^a , Benjamin Broder, MD, PhD ^d , Matthew Smith, MD ^b , George Yuen, MD ^d , Christopher Subject, MD ^b , Claudia Nau, PhD ^a,^c , Beth Creekmur, MA ^a , Sara Tartof, PhD ^a , Michael K. Gould, MD, MS ^a,^c
^a Department of Research and Evaluation, Kaiser Permanente Southern California, 100 South Los Robles, Pasadena, CA 91101, United States of America
^b Southern California Permanente Medical Group, Los Angeles Medical Center, 4867 Sunset Blvd, Los Angeles, CA 90027, United States of America
^c Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Health Systems Science, 98 S. Los Robles Ave., Pasadena, CA 91101, United States of America
^d Southern California Permanente Medical Group, Baldwin Park Medical Center, 1011 Baldwin Park Blvd, Baldwin, Park, CA 91706, United States of America

^⁎Corresponding author at: Kaiser Permanente Department of Research & Evaluation, 100 S. Los Robles Ave., Pasadena, California 91101, United States of America.Kaiser Permanente Department of Research & Evaluation100 S. Los Robles Ave.PasadenaCalifornia91101United States of America

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Abstract

Objective

Develop and validate a risk score using variables available during an Emergency Department (ED) encounter to predict adverse events among patients with suspected COVID-19.

Methods

A retrospective cohort study of adult visits for suspected COVID-19 between March 1 – April 30, 2020 at 15 EDs in Southern California. The primary outcomes were death or respiratory decompensation within 7-days. We used least absolute shrinkage and selection operator (LASSO) models and logistic regression to derive a risk score. We report metrics for derivation and validation cohorts, and subgroups with pneumonia or COVID-19 diagnoses.

Results

26,600 ED encounters were included and 1079 experienced an adverse event. Five categories (comorbidities, obesity/BMI ≥ 40, vital signs, age and sex) were included in the final score. The area under the curve (AUC) in the derivation cohort was 0.891 (95% CI, 0.880–0.901); similar performance was observed in the validation cohort (AUC = 0.895, 95% CI, 0.874–0.916). Sensitivity ranging from 100% (Score 0) to 41.7% (Score of ≥15) and specificity from 13.9% (score 0) to 96.8% (score ≥ 15). In the subgroups with pneumonia (n = 3252) the AUCs were 0.780 (derivation, 95% CI 0.759–0.801) and 0.832 (validation, 95% CI 0.794–0.870), while for COVID-19 diagnoses (n = 2059) the AUCs were 0.867 (95% CI 0.843–0.892) and 0.837 (95% CI 0.774–0.899) respectively.

Conclusion

Physicians evaluating ED patients with pneumonia, COVID-19, or symptoms suspicious for COVID-19 can apply the COVAS score to assist with decisions to hospitalize or discharge patients during the SARS CoV-2 pandemic.

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Keywords : COVID-19, Risk prediction, SARS-CoV-2, Emergency medicine