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  • Derivation and validation of a risk-stratification model for patients with probable or proven COVID-19 in EDs: the revised HOME-CoV score

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Original research
Derivation and validation of a risk-stratification model for patients with probable or proven COVID-19 in EDs: the revised HOME-CoV score
  1. Delphine Douillet1,2,
  2. Jérémie Riou3,4,
  3. François Morin1,
  4. Rafaël Mahieu5,6,
  5. Anthony Chauvin7,
  6. Stéphane Gennai8,9,
  7. Lionel Ferrant10,
  8. Raphaëlle Lopez11,
  9. Mustapha Sebbane12,
  10. Gaëtan Plantefeve13,
  11. Christian Brice14,
  12. Coralie Cayeux15,
  13. Dominique Savary16,17,
  14. Thomas Moumneh18,
  15. Andrea Penaloza19,
  16. Pierre Marie Roy1,2
  1. 1 Emergency Department, CHU Angers, University of Angers, CHU Angers, Angers, France
  2. 2 UMR MitoVasc CNRS 6015 - INSERM 1083, Health Faculty, University of Angers; FCRIN, INNOVTE, Universite Angers Faculte des sciences, Angers, France
  3. 3 Micro et Nano médecines Translationnelles, MINT, UNIV Angers, UMR INSERM 1066, UMR CNRS 6021, CHU Angers, Angers, France
  4. 4 Methodology and Biostatistics Department, Delegation to Clinical Research and Innovation, Angers University Hospital, Université Angers Faculté des Sciences, Angers, France
  5. 5 Department of Infectious Disease, Angers University Hospital; University of Angers, CHU Angers, Angers, France
  6. 6 CRCINA, Inserm U1232, University of Nantes-Angers, Universite Angers Faculte Des Sciences, Angers, France
  7. 7 Emergency Department, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Assistance Publique - Hopitaux de Paris, Paris, France
  8. 8 Emergency Department, Reims University Hospital, University Hospital Centre Reims, Reims, France
  9. 9 UFR Médecine, Université de Reims Champagne-Ardenne, Reims, France
  10. 10 Emergency Department, Université catholique de Louvain, Louvain-la-Neuve, Belgium
  11. 11 Emergency Department, Sart Tilman University Hospital, Centre hospitalier universitaire de Liège, Liege, Belgium
  12. 12 Emergency Department, Montpellier University Hospital, Montpellier, France
  13. 13 Centre Hospitalier Victor Dupouy, Argenteuil, France
  14. 14 Emergency Department, Centre Hospitalier de Saint Brieuc, Saint Brieuc, France
  15. 15 Emergency Department, Centre Hospitalier de Remiremont, Remiremont, France
  16. 16 Department of Emergency Medicine, University of Angers, ANGERS, France
  17. 17 Inserm IRSET UMR_S1085, I, EHESP, Angers, France
  18. 18 Emergency Department, CHU Angers, Angers, France
  19. 19 Emergency, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
  1. Correspondence to Dr Delphine Douillet, Emergency Department, CHU Angers, University of Angers, CHU Angers, Angers, 49100, France; delphinedouillet{at}gmail.com

Abstract

Background The HOME-CoV (Hospitalisation or Outpatient ManagEment of patients with SARS-CoV-2 infection) score is a validated list of uniquely clinical criteria indicating which patients with probable or proven COVID-19 can be treated at home. The aim of this study was to optimise the score to improve its ability to discriminate between patients who do and do not need admission.

Methods A revised HOME-CoV score was derived using data from a previous prospective multicentre study which evaluated the original Home-CoV score. Patients with proven or probable COVID-19 attending 34 EDs in France, Monaco and Belgium between April and May 2020 were included. The population was split into a derivation and validation sample corresponding to the observational and interventional phases of the original study. The main outcome was non-invasive or invasive ventilation or all-cause death within 7 days following inclusion. Two threshold values were defined using a sensitivity of >0.9 and a specificity of >0.9 to identify low-risk and high-risk patients, respectively. The revised HOME-CoV score was then validated by retrospectively applying it to patients in the same EDs with proven or probable COVID-19 during the interventional phase. The revised HOME-CoV score was also tested against original HOME-CoV, qCSI, qSOFA, CRB65 and SMART-COP in this validation cohort.

Results There were 1696 patients in the derivation cohort, of whom 65 (3.8%) required non-invasive ventilation or mechanical ventilation or died within 7 days and 1304 patients in the validation cohort, of whom 22 (1.7%) had a progression of illness. The revised score included seven clinical criteria. The area under the curve (AUC) was 87.6 (95% CI 84.7 to 90.6). The cut-offs to define low-risk and high-risk patients were <2 and >3, respectively. In the validation cohort, the AUC was 85.8 (95% CI 80.6 to 91.0). A score of <2 qualified 73% of patients as low risk with a sensitivity of 0.77 (0.55–0.92) and a negative predictive value of 0.99 (0.99–1.00).

Conclusion The revised HOME-CoV score, which does not require laboratory testing, may allow accurate risk stratification and safely qualify a significant proportion of patients with probable or proven COVID-19 for home treatment.

  • COVID-19
  • risk management
  • hospitalisations
  • clinical assessment

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/emermed-2022-212631

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Handling editor Shammi L Ramlakhan

    • Twitter @Francois_Mo_49

    • Contributors The DD, RJ, AP and PMR conceived, designed the study, managed the data. DD, FM, MR, AC, GS, FL, LR, SM, PG, BC, CC, TM, DS, PA and PMR collected data. RJ was the main statistician. RJ and DD conducted the statistical analyses. MR and DS served as scientific advisors. DD, FM, MR, AC, GS, FL, LR, SM, PG, BC, CC, TM, DS, AP and PMR discussed interpretation of data. The first draft of the manuscript was written by the DD, RJ and PMR. DD, RJ, FM, MR, AC, GS, FL, LR, SM, PG, BC, CC, TM, DS, AP and PMR contributed to the final manuscript and attest the accuracy of the data and the fidelity of the study to the protocol. DD is the guarantor and affirms that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.