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Research Article: Use of a rapid triage assessment tool to discriminate the need for hospitalisation in patients with severe COVID-19 infection presenting to an outpatient clinic: a single-centre, prospective cohort study

Date Published: 2023-11-29

Abstract:
Objectives The WHO designated individuals with low oxygen saturation, SpO2<94%, as severe SARS-CoV2 infection (COVID-19) and recommendations to seek care in a hospital setting were advised. A rapid, office-based method to select patients with severe COVID-19 who need intensive care was necessary during the peak of the pandemic. Design, setting and participants This is a prospective cohort study of patients with confirmed severe COVID-19 between September 2020 and April 2021. Outcome measures and analysis Oxygen saturation was obtained at rest (SpO2r), following exertion from a 20 m walk test (SpO2e), and the difference was calculated (SpO2?). Radiographs and laboratory values were obtained and recorded. Logistic regression models were used to determine variables associated with hospitalisation. A lung injury score was used to quantify pulmonary involvement. Results Out of 103 patients enrolled with severe COVID-19 infection, 19 (18.4%) were admitted to the hospital (no deaths). Patients managed as outpatients had a standard treatment protocol. The SpO2? and SpO2e were associated with hospitalisation (p<0.005) while SpO2r was no different between non-hospitalised and hospitalised patients (90.7%±2.7% vs 90.8%±2.3%, p=0.87). By contrast, exertional SpO2e was significantly different between non-hospitalised and hospitalised (87.3%±2.6%?vs 84.4%±3.4%, p=0.0005). The mean lung injury score was 11.0±3.5 (18-point scale) and did not discriminate against those who would need hospitalisation. Lower lung fields were significantly more involved than the upper (p<0.0001). All patients had elevated biomarkers of inflammation, C reactive protein (CRP) median 82.5 IQR (43–128.6)?mg/L and evidence of elevated liver enzymes. A logistic regression model was constructed including SpO2?, CRP and alanine aminotransferase to predict hospitalisation. Only SpO2? was significant, p=0.012, 95%?CI (1.128 to 2.704) and correctly classified 85.71% of patients who could remain at home or would need to receive treatment in the hospital. Conclusion An office-based, 20 m walk test can help diverge patients with severe COVID-19 who need escalated care. Further, an aggressive standardised treatment protocol can be used to successfully manage patients outside of hospitals despite having severe COVID-19.

Introduction:
Background Primary care and other points of entry into the medical system were often overwhelmed during the height of the SARS-CoV-2 pandemic. 1–5 The COVID-19 is cause by SARS-CoV-2 6 ; an enveloped RNA virus that causes respiratory, enteric, hepatic and neurological diseases. 7 8 Clinical and diagnostic tools for care developed rapidly but implementation within local communities was challenging. 9–13 Hospital diversions, long waits and other delays led to negative health consequences. 14 Guidance for treatment…

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