hospitalization or outpatient management of patients with sras-cov-2 infection - revised home-cov score study

Conditions: Coronavirus Infection

Summary: in the context of covid-19 pandemic, identifying low-risk patients who can be safely treated at home and high-risk patients requiring hospitalization or even intensive care is crucial for emergency departments. thanks to a consensus of experts using the delphi method, we previously defined the home-cov rule. the home-cov rule consists of 8 items precluding home treatment for patients consulting in the emergency department (ed) with confirmed or highly suspected mild to moderate covid-19. it has been validated in a prospective study, patients with a negative rule having a very-low rate of invasive ventilation or death within the 7 days following ed presentation (home-cov study, nct: 02811237). using logistic regression, we revised the home-cov rule in order to define a score allowing. the revised home-cov score comprises 7 criteria and, retrospectively assessed in the database of the home-cov study, it exhibits promising performances. a revised home-cov score \ 4 had a sensitivity of 0.41 (0.28 to 0.54), a specificity of 0.93 (0.92 to 0.94) and a positive predictive value of 0.11 (0.07 to 0.16). the present study aims to prospectively validate the revised home-cov score, firstly, in identifying a subgroup of covid-19 patients with a low risk of evolution to severe covid-19 and who could be safely treated at home. for this purpose, we will perform an interventional multicentric prospective pragmatic cohort study with implementation of the revised home-cov score to triage covid-19 patients.

in all participating emergency departments, patients with highly suspected or confirmed covid-19 are evaluated for potential inclusion. clinical, biological, and imaging data that may be involved in decision-making about hospitalization, including all criteria of the revised home-cov score, are collected. the revised home-cov score is calculated. patients with a score \ 4, hospitalization in a unit allowing monitoring of vital parameters is recommended. the qualification for home treatment or for hospitalization can be overruled by the physician-in-charge in case of major medical or social reasons. a justification explaining the cause of overruling is required. a phone-call follow-up is performed on day 7 and the patients' clinical status according to the ordinal scale for clinical improvement of covid-19 from the world health organization (who-osci) is collected.

Eligibility criteria:
inclusion criteria: * adult patient (≥ 18 years old) * admitted for covid-19 infection confirmed by a positive sars-cov2 rt-pcr or considered probable by the physician in charge of the patient. * not requiring care in intensive care unit or resuscitation unit or * no subject of a limitation decision of active therapies, * free informed express consent to participate in the study orally given or signed by the patient according to local legislation, * insurance cover according to local legislation; exclusion criteria: * patient admitted to the emergency room for 18 hours or more, * patient whose follow-up on d7 is impossible, whatever the reason, * patient already included in the study, * person deprived of their liberty by judicial or administrative decision, * person under psychiatric care under duress, * person subject to a legal protection measure, * person unable to express consent.

Keywords: outpatients covid-19 risk assessment model home treatment