Regresar

Development and validation of a pbkp_redictive model to determine the level of care in patients confirmed with COVID-19

Abstract:

Background: The COVID-19 pandemic has imposed significant challenges on hospital capacity. While mitigating unnecessary crowding in hospitals is favourable to reduce viral transmission, it is more important to prevent readmissions with impaired clinical status due to initially inappropriate level of care. A validated pbkp_redictive tool to assist clinical decisions for patient triage and facilitate remote stratification is of critical importance. Methods: We conducted a retrospective study in patients with confirmed COVID-19 stratified into two levels of care, namely ambulatory care and hospitalization. Data on socio-demographics, clinical symptoms, and comorbidities were collected during the first (N = 571) and second waves (N = 174) of the pandemic in Belgium (2 March to 6 December 2020). Univariate and multivariate logistic regressions were performed to build and validate the pbkp_rediction model. Results: Significant pbkp_redictors of hospitalization were old age (OR = 1.08, 95%CI:1.06–1.10), male gender (OR = 4.41, 95%CI: 2.58–7.52), dyspnoea (OR 6.11, 95%CI: 3.58–10.45), dry cough (OR 2.89, 95%CI: 1.54–5.41), wet cough (OR 4.62, 95%CI: 1.93–11.06), hypertension (OR 2.20, 95%CI: 1.17–4.16) and renal failure (OR 5.39, 95%CI: 1.00–29.00). Rhinorrhea (OR 0.43, 95%CI: 0.24–0.79) and headache (OR 0.36, 95%CI: 0.20–0.65) were negatively associated with hospitalization. A receiver operating characteristic (ROC) curve was constructed and the area under the ROC curve was 0.931 (95% CI: 0.910–0.953) for the pbkp_rediction model (first wave) and 0.895 (95% CI: 0.833–0.957) for the validated dataset (second wave). Conclusion: With a good discriminating power, the pbkp_rediction model might identify patients who require ambulatory care or hospitalization and support clinical decisions by Emergency Department staff and general practitioners.