RESEARCH LETTER
Mark H. Ebell, MD, MS; Roya Hamadani, MPH; Autumn Kieber-Emmons, MD, MPH
Corresponding Author: Mark H. Ebell, MD, MS; University of Georgia - College of Public Health
Email: ebell@uga.edu
DOI: 10.3122/jabfm.2023.230208R1
Keywords: Clinical Decision Support Systems, Clinical Prediction Rule, COVID-19, Epidemiology, Hospitalization, Infectious Diseases, Medical Decision-Making, Pandemics, Primary Health Care, Prognosis, Risk Scores, Triage
Dates: Submitted: 05-31-2023; Revised: 10-03-2023; Accepted: 10-09-2023
FINAL PUBLICATION: |HTML| |PDF|
INTRODUCTION: We previously developed a simple risk score with 3 items (age, patient report of dyspnea, and any relevant comorbidity), and in this report validate it in a prospective sample of patients, stratified by vaccination status.
METHODS: Data were abstracted from a structured electronic health record of primary care and urgent care patients with COVID-19 in the Lehigh Valley Health Network from 11/21/2021 and 10/31/2022 (Omicron variant). Our previously derived risk score was calculated for each of 19,456 patients, and the likelihood of hospitalization was determined. Area under the ROC curve was calculated.
RESULTS: We were able to place 13,239 patients (68%) in a low-risk group with only a 0.16% risk of hospitalization. The moderate risk group with 5622 patients had a 2.2% risk of hospitalization and might benefit from close outpatient follow-up, while the high-risk group with only 574 patients (2.9% of all patients) had an 8.9% risk of hospitalization and may require further evaluation. Area under the curve was 0.844.
DISCUSSION: We prospectively validated a simple risk score for primary and urgent care patients with COVID-19 that can support outpatient triage decisions around COVID-19. The Lehigh Outpatient COVID Hospitalization (LOCH) risk score is available online as a free app: https://ebell-projects.shinyapps.io/LehighRiskScore/