Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Dec 22;3(6):e12868.
doi: 10.1002/emp2.12868. eCollection 2022 Dec.

Derivation and validation of a clinical decision rule to risk-stratify COVID-19 patients discharged from the emergency department: The CCEDRRN COVID discharge score

Affiliations

Derivation and validation of a clinical decision rule to risk-stratify COVID-19 patients discharged from the emergency department: The CCEDRRN COVID discharge score

Steven C Brooks et al. J Am Coll Emerg Physicians Open. .

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.

Keywords: COVID‐19; clinical decision instrument; clinical prediction score; coronavirus disease; emergency medicine; prediction model.

PubMed Disclaimer

Conflict of interest statement

The authors have declared no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow diagram of included and excluded emergency department visits. Abbreviations: CCEDRRN, Canadian COVID‐19 Emergency Department Rapid Response Network; DNR, do not resuscitate; ED, emergency department; SARS‐CoV‐2, severe acute respiratory syndrome coronavirus‐2.
FIGURE 2
FIGURE 2
Distribution and performance of the CCEDRRN COVID discharge score in the derivation cohort (left panel) and validation cohort (right panel): (A) distribution of the score, (B) observed death or hospital admission within 72 h of ED discharge across the range of the score, (C) predicted versus observed probability of death of hospital admission within 72 h of ED discharge, and (D) receiver operating characteristic curve with area under the curve (AUC) and associated 95% confidence intervals.

Similar articles

Cited by

References

    1. Verma AA, Hora T, Jung HY, et al. Characteristics and outcomes of hospital admissions for COVID‐19 and influenza in the Toronto area. Can Med Assoc J. 2021;193(12):E410‐E418. doi: 10.1503/cmaj.202795 - DOI - PMC - PubMed
    1. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID‐19 in the New York City area. JAMA. 2020;323(20):2052‐2059. doi: 10.1001/jama.2020.6775 - DOI - PMC - PubMed
    1. Gao Z, Xu Y, Sun C, et al. A systematic review of asymptomatic infections with COVID‐19. J Microbiol Immunol Infect. 2021;54(1):12‐16. (In eng). doi: 10.1016/j.jmii.2020.05.001 - DOI - PMC - PubMed
    1. Hohl CM, Rosychuk RJ, Hau JP, et al. Treatments, resource utilization, and outcomes of COVID‐19 patients presenting to emergency departments across pandemic waves: an observational study by the Canadian COVID‐19 emergency department rapid response network (CCEDRRN). Can J Emerg Med. 2022. doi: 10.1007/s43678-022-00275-3 - DOI - PMC - PubMed
    1. Beiser DG, Jarou ZJ, Kassir AA, et al. Predicting 30‐day return hospital admissions in patients with COVID‐19 discharged from the emergency department: a national retrospective cohort study. J Am Coll Emerg Physicians Open. 2021;2(6):e12595. (In eng). doi: 10.1002/emp2.12595 - DOI - PMC - PubMed