Silvia Solà1, Javier Jacob2, Youcef Azeli3, Josep Trenado4, Jorge Morales-Álvarez5, Francesc Xavier Jiménez-Fàbrega6. 1. Sistema d'Emergències Mèdiques de Catalunya, España. Grupo RINVEMER. Red de Investigación de Emergencias Prehospitalarias. 2. Servei d'Urgències Hospital Universitari de Bellvitge, Barcelona, España. 3. Sistema d'Emergències Mèdiques de Catalunya, España. Servei d'Urgencies Hospital Universitari Sant Joan de Reus, Tarragona, España. Institut d'Investigació Sanitària Pere Virgili, Tarragona, España. 4. Sistema d'Emergències Mèdiques de Catalunya, España. Servei Medicina Intensiva UCI-Semicritics, Hospital Universitario Mutua de Terrassa, Barcelona, España. 5. Sistema d'Emergències Mèdiques de Catalunya, España. 6. Sistema d'Emergències Mèdiques de Catalunya, España. Universitat de Barcelona. Barcelona, España. Grupo RINVEMER. Red de Investigación de Emergencias Prehospitalarias.
Abstract
OBJECTIVES: To develop and validate a triage scale (Spanish acronym, TIHCOVID) to assign priority by predicting critical events in patients with severe COVID-19 who are candidates for interhospital transfer. MATERIAL AND METHODS: Prospective cohort study in 2 periods for internal (February-April 2020) and external (October-December 2020) validation. We included consecutive patients with severe COVID-19 who were transported by the emergency medical service of Catalonia. A risk model was developed to predict mortality based on variables recorded on first contact between the regional emergency coordination center and the transferring hospital. The model's performance was evaluated by means of calibration and discrimination, and the results for the first and second periods were compared. RESULTS: Nine hundred patients were included, 450 in each period. In-hospital mortality was 33.8%. The 7 predictors included in the final model were age, comorbidity, need for prone positioning, renal insufficiency, use of high-flow nasal oxygen prior to mechanical ventilation, and a ratio of PaO2 to inspired oxygen fraction of less than 50. The performance of the model was good (Brier score, 0.172), and calibration and discrimination were consistent. We found no significant differences between the internal and external validation steps with respect to either the calibration slopes (0.92 [95% CI, 0.91-0.93] vs 1.12 [95% CI, 0.6-1.17], respectively; P = .150) or discrimination (area under the curve, 0.81 [95% CI, 0.75-0.84] vs 0.85 [95% CI, 0.81-0.89]; P = .121). CONCLUSION: The TIHCOVID tool may be useful for triage when assigning priority for patients with severe COVID-19 who require transfer between hospitals.
OBJECTIVES: To develop and validate a triage scale (Spanish acronym, TIHCOVID) to assign priority by predicting critical events in patients with severe COVID-19 who are candidates for interhospital transfer. MATERIAL AND METHODS: Prospective cohort study in 2 periods for internal (February-April 2020) and external (October-December 2020) validation. We included consecutive patients with severe COVID-19 who were transported by the emergency medical service of Catalonia. A risk model was developed to predict mortality based on variables recorded on first contact between the regional emergency coordination center and the transferring hospital. The model's performance was evaluated by means of calibration and discrimination, and the results for the first and second periods were compared. RESULTS: Nine hundred patients were included, 450 in each period. In-hospital mortality was 33.8%. The 7 predictors included in the final model were age, comorbidity, need for prone positioning, renal insufficiency, use of high-flow nasal oxygen prior to mechanical ventilation, and a ratio of PaO2 to inspired oxygen fraction of less than 50. The performance of the model was good (Brier score, 0.172), and calibration and discrimination were consistent. We found no significant differences between the internal and external validation steps with respect to either the calibration slopes (0.92 [95% CI, 0.91-0.93] vs 1.12 [95% CI, 0.6-1.17], respectively; P = .150) or discrimination (area under the curve, 0.81 [95% CI, 0.75-0.84] vs 0.85 [95% CI, 0.81-0.89]; P = .121). CONCLUSION: The TIHCOVID tool may be useful for triage when assigning priority for patients with severe COVID-19 who require transfer between hospitals.
Entities:
Keywords:
COVID-19.; Critical care.; Cuidados críticos.; Disaster planning..; Emergency health services.; Planificación de desastres.; Planificación de salud regional.; Regional health planning..; Servicios de Emergencias Médicos.
Authors: Arantxa Albert; Pere Llorens; Alfons Aguirre; Francisco Javier Martín-Sánchez; Silvia Mínguez; Oscar Moreno; Carles Ferré; Adrián Valls; Begoña Espinosa; Oscar Murillo; Isabel Cirera; Adriana Gil; Samuel Rivera; Ferran Llopis; Pierre Malchair; Juan Gonzalez Del Castillo; Javier Jacob Journal: J Healthc Qual Res Date: 2022-06-08