Risk stratification through implementation and evaluation of a COVID-19 score : A retrospective diagnostic study

• Published in: Medizinische Klinik, Intensivmedizin und Notfallmedizin Vol. 115; no. Suppl 3; pp. 132 - 138
• Main Authors: Hüfner, A, Kiefl, D, Baacke, M, Zöllner, R, Loza Mencía, E, Schellein, O, Avan, N, Pemmerl, S
• Format: Journal Article
• Language: German
• Published: Germany 01-12-2020
• Subjects: COVID-19; Humans; Retrospective Studies; Risk Assessment; SARS-CoV-2; Virus Diseases; COVID-19; Score; SARS-CoV‑2; Emergency department; Emergency medicine
• ISSN: 2193-6226
• DOI: 10.1007/s00063-020-00754-4

The clinical manifestation of COVID-19 is nonspecific and varies greatly, which makes it more difficult to discriminate from other (virus) infections. Neither individual findings nor combinations of findings are specific enough to be able to diagnose COVID-19 with a high degree of certainty. The goal was to identify patients in the emergency department, who are at risk for COVID-19 disease, early by using a score, so that they could be isolated pre-emptively.
Development and implementation of a symptom-based COVID-19 score based on a multicentric retrospective evaluation in three German emergency departments from 9 March until 30 April 2020 of patients suspected of having COVID-19 and subsequent SARS-CoV‑2 PCR testing.
The study population included 697 patients and 9.4% of these patients were diagnosed with COVID-19 infection. A COVID-19 score of ≥5 points was associated with a significantly increased likelihood of illness. The sensitivity of the score was 98.4% with a moderate specificity of 48.3%.
The score, which is easy to obtain during the initial assessment, supports the assessment of the pretest probability for a COVID-19 infection as part of the risk stratification and can influence the treatment pathway in terms of pre-emptive isolation, PCR testing and other treatment options at an early stage. Due to the nonspecific symptoms of the disease; however, it must be accepted that the goal of high sensitivity results in a relatively low specificity of the score.