What items should be included in an early warning score for remote assessment of suspected COVID-19? qualitative and Delphi study
Background To develop items for an early warning score (RECAP: REmote COVID-19 Assessment in Primary Care) for patients with suspected COVID-19 who need escalation to next level of care.Methods The study was based in UK primary healthcare. The mixed-methods design included rapid review, Delphi panel...
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BMJ Publishing Group
2020-11-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/11/e042626.full |
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| author | David Nunan Simon de Lusignan Ana Luísa Neves Laiba Husain Brendan Delaney Paul Thompson Sietse Weiringa Merlin Dunlop Alexander Rushforth |
| author_facet | David Nunan Simon de Lusignan Ana Luísa Neves Laiba Husain Brendan Delaney Paul Thompson Sietse Weiringa Merlin Dunlop Alexander Rushforth |
| author_sort | David Nunan |
| collection | DOAJ |
| description | Background To develop items for an early warning score (RECAP: REmote COVID-19 Assessment in Primary Care) for patients with suspected COVID-19 who need escalation to next level of care.Methods The study was based in UK primary healthcare. The mixed-methods design included rapid review, Delphi panel, interviews, focus groups and software development. Participants were 112 primary care clinicians and 50 patients recovered from COVID-19, recruited through social media, patient groups and snowballing. Using rapid literature review, we identified signs and symptoms which are commoner in severe COVID-19. Building a preliminary set of items from these, we ran four rounds of an online Delphi panel with 72 clinicians, the last incorporating fictional vignettes, collating data on R software. We refined the items iteratively in response to quantitative and qualitative feedback. Items in the penultimate round were checked against narrative interviews with 50 COVID-19 patients. We required, for each item, at least 80% clinician agreement on relevance, wording and cut-off values, and that the item addressed issues and concerns raised by patients. In focus groups, 40 clinicians suggested further refinements and discussed workability of the instrument in relation to local resources and care pathways. This informed design of an electronic template for primary care systems.Results The prevalidation RECAP-V0 comprises a red flag alert box and 10 assessment items: pulse, shortness of breath or respiratory rate, trajectory of breathlessness, pulse oximeter reading (with brief exercise test if appropriate) or symptoms suggestive of hypoxia, temperature or fever symptoms, duration of symptoms, muscle aches, new confusion, shielded list and known risk factors for poor outcome. It is not yet known how sensitive or specific it is.Conclusions Items on RECAP-V0 align strongly with published evidence, clinical judgement and patient experience. The validation phase of this study is ongoing.Trial registration number NCT04435041. |
| format | Article |
| id | doaj-art-4bc4630265be49b4baa1d15d3cd4da36 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-4bc4630265be49b4baa1d15d3cd4da362025-08-20T02:23:08ZengBMJ Publishing GroupBMJ Open2044-60552020-11-01101110.1136/bmjopen-2020-042626What items should be included in an early warning score for remote assessment of suspected COVID-19? qualitative and Delphi studyDavid Nunan0Simon de Lusignan1Ana Luísa Neves2Laiba Husain3Brendan Delaney4Paul Thompson5Sietse Weiringa6Merlin Dunlop7Alexander Rushforth8Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UKRoyal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC), London, UKCentre for Health Technology and Services Research, Department of Community Medicine, Information and Health Decision Sciences, University of Porto, Porto, Portugal1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKInstitute of Global Health Innovation, Imperial College London, London, UK1University of Birmingham, UKNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKArdens Ltd, Oxford, UK1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKBackground To develop items for an early warning score (RECAP: REmote COVID-19 Assessment in Primary Care) for patients with suspected COVID-19 who need escalation to next level of care.Methods The study was based in UK primary healthcare. The mixed-methods design included rapid review, Delphi panel, interviews, focus groups and software development. Participants were 112 primary care clinicians and 50 patients recovered from COVID-19, recruited through social media, patient groups and snowballing. Using rapid literature review, we identified signs and symptoms which are commoner in severe COVID-19. Building a preliminary set of items from these, we ran four rounds of an online Delphi panel with 72 clinicians, the last incorporating fictional vignettes, collating data on R software. We refined the items iteratively in response to quantitative and qualitative feedback. Items in the penultimate round were checked against narrative interviews with 50 COVID-19 patients. We required, for each item, at least 80% clinician agreement on relevance, wording and cut-off values, and that the item addressed issues and concerns raised by patients. In focus groups, 40 clinicians suggested further refinements and discussed workability of the instrument in relation to local resources and care pathways. This informed design of an electronic template for primary care systems.Results The prevalidation RECAP-V0 comprises a red flag alert box and 10 assessment items: pulse, shortness of breath or respiratory rate, trajectory of breathlessness, pulse oximeter reading (with brief exercise test if appropriate) or symptoms suggestive of hypoxia, temperature or fever symptoms, duration of symptoms, muscle aches, new confusion, shielded list and known risk factors for poor outcome. It is not yet known how sensitive or specific it is.Conclusions Items on RECAP-V0 align strongly with published evidence, clinical judgement and patient experience. The validation phase of this study is ongoing.Trial registration number NCT04435041.https://bmjopen.bmj.com/content/10/11/e042626.full |
| spellingShingle | David Nunan Simon de Lusignan Ana Luísa Neves Laiba Husain Brendan Delaney Paul Thompson Sietse Weiringa Merlin Dunlop Alexander Rushforth What items should be included in an early warning score for remote assessment of suspected COVID-19? qualitative and Delphi study BMJ Open |
| title | What items should be included in an early warning score for remote assessment of suspected COVID-19? qualitative and Delphi study |
| title_full | What items should be included in an early warning score for remote assessment of suspected COVID-19? qualitative and Delphi study |
| title_fullStr | What items should be included in an early warning score for remote assessment of suspected COVID-19? qualitative and Delphi study |
| title_full_unstemmed | What items should be included in an early warning score for remote assessment of suspected COVID-19? qualitative and Delphi study |
| title_short | What items should be included in an early warning score for remote assessment of suspected COVID-19? qualitative and Delphi study |
| title_sort | what items should be included in an early warning score for remote assessment of suspected covid 19 qualitative and delphi study |
| url | https://bmjopen.bmj.com/content/10/11/e042626.full |
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