Clinical stability and in-hospital mortality prediction in COVID-19 patients presenting to the Emergency Department

BACKGROUND: The Novara-COVID score was developed to help the Emergency Physician to decide which Coronavirus disease (COVID) patient required hospitalization at emergency department (ED) presentation and to which intensity of care We aimed at evaluating its prognostic role METHODS: We retrospectively collected data of COVID patients admitted to our ED between March 16th and April 22nd, 2020 The Novara-COVID score was systematically applied to all COVID patients since its introduction in clinical practice and adopted to decide patients' destination The ability of the Novara-COVID score to predict in-hospital clinical stability and in-hospital mortality were evaluated through multivariable logistic regression and Cox Regression Hazard models, respectively RESULTS: Among the 480 COVID patients admitted to the ED, 338 were hospitalized: the Novara-COVID score was 0-1 in 49 7%, 2 in 24 6%, 3 in 15 4% and 4-5 in 10 3% of patients Novara-COVID score values of 3 and 4-5 were associated with lower clinical stability with adjusted odds ratios of 0 28 [0 13-0 59] and 0 03 [0 01-0 12], respectively When in-hospital mortality was evaluated, a significant difference emerged between scores of 0-1 and 2 vs 3 and 4-5 In particular, the death adjusted Hazard Ratio for Novara-COVID scores of 3 and 4-5 were 2 6 [1 4-4 8] and 8 4 [4 7-15 2], respectively CONCLUSIONS: The Novara-COVID score reliably predicts in-hospital clinical instability and mortality of COVID patients at ED presentation This tool allows the Emergency Physician to detect patients at higher risk of clinical deterioration, suggesting a more aggressive therapeutic management from the beginning