Derivation and validation of a clinical decision rule to risk‐stratify COVID‐19 patients discharged from the emergency department: The CCEDRRN COVID discharge score
Abstract Objective To risk‐stratify COVID‐19 patients being considered for discharge from the emergency department (ED). Methods We conducted an observational study to derive and validate a clinical decision rule to identify COVID‐19 patients at risk for hospital admission or death within 72 hours o...
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Elsevier
2022-12-01
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| Series: | Journal of the American College of Emergency Physicians Open |
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| Online Access: | https://doi.org/10.1002/emp2.12868 |
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| author | Steven C. Brooks Rhonda J. Rosychuk Jeffrey J. Perry Laurie J. Morrison Hana Wiemer Patrick Fok Brian H. Rowe Raoul Daoust Shabnam Vatanpour Joel Turner Megan Landes Robert Ohle Jake Hayward Frank Scheuermeyer Michelle Welsford Corinne Hohl the Canadian COVID‐19 Rapid Response Network (CCEDRRN) for the Network of Canadian Emergency Researchers (NCER) and the Canadian Critical Care Trials Group (CCCTG) |
| author_facet | Steven C. Brooks Rhonda J. Rosychuk Jeffrey J. Perry Laurie J. Morrison Hana Wiemer Patrick Fok Brian H. Rowe Raoul Daoust Shabnam Vatanpour Joel Turner Megan Landes Robert Ohle Jake Hayward Frank Scheuermeyer Michelle Welsford Corinne Hohl the Canadian COVID‐19 Rapid Response Network (CCEDRRN) for the Network of Canadian Emergency Researchers (NCER) and the Canadian Critical Care Trials Group (CCCTG) |
| author_sort | Steven C. Brooks |
| collection | DOAJ |
| description | Abstract Objective To risk‐stratify COVID‐19 patients being considered for discharge from the emergency department (ED). Methods We conducted an observational study to derive and validate a clinical decision rule to identify COVID‐19 patients at risk for hospital admission or death within 72 hours of ED discharge. We used data from 49 sites in the Canadian COVID‐19 Emergency Department Rapid Response Network (CCEDRRN) between March 1, 2020, and September 8, 2021. We randomly assigned hospitals to derivation or validation and prespecified clinical variables as candidate predictors. We used logistic regression to develop the score in a derivation cohort and examined its performance in predicting short‐term adverse outcomes in a validation cohort. Results Of 15,305 eligible patient visits, 535 (3.6%) experienced the outcome. The score included age, sex, pregnancy status, temperature, arrival mode, respiratory rate, and respiratory distress. The area under the curve was 0.70 (95% confidence interval [CI] 0.68–0.73) in derivation and 0.71 (95% CI 0.68–0.73) in combined derivation and validation cohorts. Among those with a score of 3 or less, the risk for the primary outcome was 1.9% or less, and the sensitivity of using 3 as a rule‐out score was 89.3% (95% CI 82.7–94.0). Among those with a score of ≥9, the risk for the primary outcome was as high as 12.2% and the specificity of using 9 as a rule‐in score was 95.6% (95% CI 94.9–96.2). Conclusion The CCEDRRN COVID discharge score can identify patients at risk of short‐term adverse outcomes after ED discharge with variables that are readily available on patient arrival. |
| format | Article |
| id | doaj-art-14e12d4ac80f46f3b6548858a9b05d8e |
| institution | DOAJ |
| issn | 2688-1152 |
| language | English |
| publishDate | 2022-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj-art-14e12d4ac80f46f3b6548858a9b05d8e2025-08-20T03:17:22ZengElsevierJournal of the American College of Emergency Physicians Open2688-11522022-12-0136n/an/a10.1002/emp2.12868Derivation and validation of a clinical decision rule to risk‐stratify COVID‐19 patients discharged from the emergency department: The CCEDRRN COVID discharge scoreSteven C. Brooks0Rhonda J. Rosychuk1Jeffrey J. Perry2Laurie J. Morrison3Hana Wiemer4Patrick Fok5Brian H. Rowe6Raoul Daoust7Shabnam Vatanpour8Joel Turner9Megan Landes10Robert Ohle11Jake Hayward12Frank Scheuermeyer13Michelle Welsford14Corinne Hohl15the Canadian COVID‐19 Rapid Response Network (CCEDRRN) for the Network of Canadian Emergency Researchers (NCER) and the Canadian Critical Care Trials Group (CCCTG)16Departments of Emergency Medicine and Public Health SciencesQueen's University KingstonOntarioCanadaDepartment of Pediatrics University of Alberta Edmonton Alberta CanadaDepartment of Emergency Medicine University of Ottawa Ottawa Ontario CanadaDepartment of Emergency Services, Sunnybrook Health Sciences Centre, Department of Medicine, Division of Emergency Medicine University of Toronto Toronto Ontario CanadaDepartment of Emergency Medicine Dalhousie University Halifax Nova Scotia CanadaDepartment of Emergency Medicine Dalhousie University Halifax Nova Scotia CanadaDepartment of Emergency Medicine University of Alberta Edmonton Alberta CanadaDepartement de Médecine de Famille et Médecine d'urgence Université de Montréal Montréal Québec CanadaDepartment of Emergency Medicine University of Calgary Calgary Alberta CanadaDepartment of Emergency Medicine McGill University Montréal Québec CanadaDepartment of Family and Community Medicine Division of Emergency Medicine University of Toronto Toronto Ontario CanadaDepartment of Emergency Medicine, Health Science North Research Institute Northern Ontario School of Medicine Sudbury Ontario CanadaDepartment of Emergency Medicine University of Alberta Edmonton Alberta CanadaDepartment of Emergency Medicine University of British Columbia Vancouver British Columbia CanadaDepartment of Medicine, Division of Emergency Medicine McMaster University Hamilton Ontario CanadaDepartment of Emergency Medicine University of British Columbia Vancouver British Columbia CanadaDepartments of Emergency Medicine and Public Health SciencesQueen's University KingstonOntarioCanadaAbstract Objective To risk‐stratify COVID‐19 patients being considered for discharge from the emergency department (ED). Methods We conducted an observational study to derive and validate a clinical decision rule to identify COVID‐19 patients at risk for hospital admission or death within 72 hours of ED discharge. We used data from 49 sites in the Canadian COVID‐19 Emergency Department Rapid Response Network (CCEDRRN) between March 1, 2020, and September 8, 2021. We randomly assigned hospitals to derivation or validation and prespecified clinical variables as candidate predictors. We used logistic regression to develop the score in a derivation cohort and examined its performance in predicting short‐term adverse outcomes in a validation cohort. Results Of 15,305 eligible patient visits, 535 (3.6%) experienced the outcome. The score included age, sex, pregnancy status, temperature, arrival mode, respiratory rate, and respiratory distress. The area under the curve was 0.70 (95% confidence interval [CI] 0.68–0.73) in derivation and 0.71 (95% CI 0.68–0.73) in combined derivation and validation cohorts. Among those with a score of 3 or less, the risk for the primary outcome was 1.9% or less, and the sensitivity of using 3 as a rule‐out score was 89.3% (95% CI 82.7–94.0). Among those with a score of ≥9, the risk for the primary outcome was as high as 12.2% and the specificity of using 9 as a rule‐in score was 95.6% (95% CI 94.9–96.2). Conclusion The CCEDRRN COVID discharge score can identify patients at risk of short‐term adverse outcomes after ED discharge with variables that are readily available on patient arrival.https://doi.org/10.1002/emp2.12868clinical decision instrumentclinical prediction scorecoronavirus diseaseCOVID‐19emergency medicineprediction model |
| spellingShingle | Steven C. Brooks Rhonda J. Rosychuk Jeffrey J. Perry Laurie J. Morrison Hana Wiemer Patrick Fok Brian H. Rowe Raoul Daoust Shabnam Vatanpour Joel Turner Megan Landes Robert Ohle Jake Hayward Frank Scheuermeyer Michelle Welsford Corinne Hohl the Canadian COVID‐19 Rapid Response Network (CCEDRRN) for the Network of Canadian Emergency Researchers (NCER) and the Canadian Critical Care Trials Group (CCCTG) Derivation and validation of a clinical decision rule to risk‐stratify COVID‐19 patients discharged from the emergency department: The CCEDRRN COVID discharge score Journal of the American College of Emergency Physicians Open clinical decision instrument clinical prediction score coronavirus disease COVID‐19 emergency medicine prediction model |
| title | Derivation and validation of a clinical decision rule to risk‐stratify COVID‐19 patients discharged from the emergency department: The CCEDRRN COVID discharge score |
| title_full | Derivation and validation of a clinical decision rule to risk‐stratify COVID‐19 patients discharged from the emergency department: The CCEDRRN COVID discharge score |
| title_fullStr | Derivation and validation of a clinical decision rule to risk‐stratify COVID‐19 patients discharged from the emergency department: The CCEDRRN COVID discharge score |
| title_full_unstemmed | Derivation and validation of a clinical decision rule to risk‐stratify COVID‐19 patients discharged from the emergency department: The CCEDRRN COVID discharge score |
| title_short | Derivation and validation of a clinical decision rule to risk‐stratify COVID‐19 patients discharged from the emergency department: The CCEDRRN COVID discharge score |
| title_sort | derivation and validation of a clinical decision rule to risk stratify covid 19 patients discharged from the emergency department the ccedrrn covid discharge score |
| topic | clinical decision instrument clinical prediction score coronavirus disease COVID‐19 emergency medicine prediction model |
| url | https://doi.org/10.1002/emp2.12868 |
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