@article {Vizcaychipi630, author = {Marcela P Vizcaychipi and Claire L Shovlin and Alex McCarthy and Alice Howard and Alexander Brown and Michelle Hayes and Suveer Singh and Linsey Christie and Alice Sisson and Roger Davies and Christopher Lockie and Monica Popescu and Amandeep Gupta and James Armstrong and Hisham Said and Timothy Peters and Richard T Keays}, editor = {, and , and Christopher, Abela and Ahmed, Al-Hindawi and Joanna, Allam and Mauro, Arrica and Christelle, At and Javier, Bargados and Madeleine, Beach and Ian, Beveridge and Neil, Bodagh and Peter, Brooks and Alexander, Brown and Tom, Browning and Charo, Bruce and Kiran, Chima and James, Cofie and Harriet, Collier and Jonathan, Collier and Declan, Collins and Karen, Collins and Deirdre, Conway and Victoria, Cordrey and Caroline, Cormack and Alona, Courtney and Mark, Cox and Cox, Sarah and Joshua, Cuddihy and Aleck, Dalrymple and Paramjeet, Deol and Daryl, Dob and Juliet, Dunn and Jackeline, Durbridge and Simon, Eccles and Jana, Elbadaoui and Muna, Elsawahli and Niveen, El-Wahab and Philippa, Evans and Noel, Fee and Emma, Forman and Gabriela, Frunza and Susan, Gallagher and Rea, Ganatra and Ajay, Gandhi and Davies, Gary and Clare, Glicksman and Joseph, Gonzales and Lisa, Greaney and Samuel, Greenhalgh and Samuel, Gregson and Kevin, Haire and Sofia, Hanger and Seleena, Haque and Alison, Hare and Charlie, Hensher and Maria, Herincs and Alice, Howard and Martine, Howard and Jones, Isabel and Andrzej, Jandziol and Mo, Jawad and John, Jeans and Jo, Jennings and Max, Julve and Kaur, Khera Jacyntha and Ami, Kotecha and Manisha, Kulkarni and Holly, Lamont and Corina, Lee and Lee, Phillip and William, Lever and Li Alex, Lignos Leda and Ganga, Liyanage and Samantha, Luff and Wanda, Lui and Georgios, Malietzis and Georgina, Margiotta and Zuzanna, Matasova and Daniel, McNaughton and Ayo, Meduoye and Hannah, Mills and Alex, Milne and Marco, Morosin and Sarah, Morton and Kenneth, Murray and Quentin, Nelson and Saaman, Neriman and Lisa, Newell and Bernard, Norman and Emma, Norton and Ben, Nurdin and Catherine, Onuorah and Leyla, Osman and Catherine, O{\textquoteright}Sullivan and Chandni, Parikh and Saqib, Parwez and Shashank, Patil and Sherina, Peroos and Elspeth, Pickering and Kris, Pillay and Rob, Pilling and Martin, Porter-Moore and Olivera, Potparic and Kate, Richardson and John, Roa and Eleanor, Roderick and Katherine, Russell and Atika, Sabharwal and Amee, Samani and Aleksei, Sedov and Natalie, Silvey and Jonathan, Simon and James, Smellie and Rebecca-Lea, Smith and Andrew, Snell and Jagdish, Sokhi and Ewelina, Szubert and Ben, Thomas and John, Thornton and Lopes, Vieira Jose and Leon, Villapalos Jorge and Annette, Volger and Paul, Waddell and Josh, Wall and Kate, Wannap and Patrick, Ward and Ilhan, Wardhere and Andrea, Weigert and Helen, Westall and Maria, Wilk and Andrew, Williams and Jessica, Williams and William, Wynn-Jones and Steve, Yentis and Noel, Young}, title = {Development and implementation of a COVID-19 near real-time traffic light system in an acute hospital setting}, volume = {37}, number = {10}, pages = {630--636}, year = {2020}, doi = {10.1136/emermed-2020-210199}, publisher = {British Association for Accident and Emergency Medicine}, abstract = {Common causes of death in COVID-19 due to SARS-CoV-2 include thromboembolic disease, cytokine storm and adult respiratory distress syndrome (ARDS). Our aim was to develop a system for early detection of disease pattern in the emergency department (ED) that would enhance opportunities for personalised accelerated care to prevent disease progression. A single Trust{\textquoteright}s COVID-19 response control command was established, and a reporting team with bioinformaticians was deployed to develop a real-time traffic light system to support clinical and operational teams. An attempt was made to identify predictive elements for thromboembolism, cytokine storm and ARDS based on physiological measurements and blood tests, and to communicate to clinicians managing the patient, initially via single consultants. The input variables were age, sex, and first recorded blood pressure, respiratory rate, temperature, heart rate, indices of oxygenation and C-reactive protein. Early admissions were used to refine the predictors used in the traffic lights. Of 923 consecutive patients who tested COVID-19 positive, 592 (64\%) flagged at risk for thromboembolism, 241/923 (26\%) for cytokine storm and 361/923 (39\%) for ARDS. Thromboembolism and cytokine storm flags were met in the ED for 342 (37.1\%) patients. Of the 318 (34.5\%) patients receiving thromboembolism flags, 49 (5.3\% of all patients) were for suspected thromboembolism, 103 (11.1\%) were high-risk and 166 (18.0\%) were medium-risk. Of the 89 (9.6\%) who received a cytokine storm flag from the ED, 18 (2.0\% of all patients) were for suspected cytokine storm, 13 (1.4\%) were high-risk and 58 (6.3\%) were medium-risk. Males were more likely to receive a specific traffic light flag. In conclusion, ED predictors were used to identify high proportions of COVID-19 admissions at risk of clinical deterioration due to severity of disease, enabling accelerated care targeted to those more likely to benefit. Larger prospective studies are encouraged.}, issn = {1472-0205}, URL = {https://emj.bmj.com/content/37/10/630}, eprint = {https://emj.bmj.com/content/37/10/630.full.pdf}, journal = {Emergency Medicine Journal} }