Five indicator system can assess COVID threat to life

Specialist doctors from the world’s leading heart and lung hospitals have identified the five core measurements to establish an accurate risk of mortality for Covid-19 patients.

The team from the Royal Brompton and Harefield hospitals worked with West Hertfordshire Hospitals NHS Trust, Liverpool University Hospitals NHS Foundation Trust, and St George’s University Hospitals NHS Foundation Trust to develop a set of health measurements to help clinicians determine the level of care patients with Covid-19 will need.

The health measurements – also known as clinical predictors – are used to produce a score that identifies the risk of death from Covid-19 on a scale of 0 (low risk) to 3 (high risk). From this score, it can be determined which patients need in-hospital care and who can safely return home and be monitored remotely.

Named SOARS, the score uses the following clinical predictors:

  • SpO2 levels (the amount of oxygen in the blood)
  • Obesity
  • Age
  • Respiratory rate (the number of breaths taken per minute)
  • Stroke history.

In the study, published in leading respiratory medicine journal Thorax, combining these five measurements proved to be more accurate at predicting death from Covid-19 than age alone, the strongest single indicator of Covid-19 mortality. The score is also practical for triage doctors to perform pre-admission, as all five are easy to measure as they require no complex tests or laboratory data, enabling frontline staff to assess the risk of mortality of patients quicker.

Explaining how the SOARS score could help clinicians decide when to admit Covid-19 patients to hospital, Dr Felix Chua, Consultant in respiratory medicine at Royal Brompton Hospital and co-lead author of the study, said: “This research came about very quickly during the first wave of Covid-19. We knew that clinical teams would need a way to quickly work out which patients were the most at risk so that we did not miss anyone who needed medical help, but also did not unnecessarily admit someone to hospital who was unlikely to need emergency care – all the while keeping staff as safe as possible. This resulted in a ‘virtual hospital’ where patients at low risk of death could be monitored from home by clinical staff.”

In the study, patients with a very low risk of mortality (scoring a 2 on the SOARS scale) could be sent home with an oximeter (a device that clips over the finger to measure oxygen blood levels) and monitored through daily phone calls by a healthcare team, to ensure their symptoms and oxygen levels were not getting worse.

“Monitoring some patients remotely means hospitals can avoid unnecessary admissions but in a way that does not put patients at risk, while freeing up beds for those who need urgent hospital care”, Dr Chua added. “When we looked at the clinical data of more than 15,000 patients who were admitted to hospital with Covid-19, we found that between 16–30 per cent could have been monitored from home.”

Co-lead author Dr Rama Vancheeswaran, consultant chest and general physician at West Hertfordshire NHS Trust and honorary consultant at Royal Brompton Hospital, said: “We began using the score during the second surge of Covid-19 patients at Watford hospital and it has been a really efficient way to quickly and safely triage patients, identifying the sickest. It has also encouraged patients to report to hospital with Covid-19 symptoms sooner, as many people stayed home to avoid overburdening the NHS for as long as possible. But with this score we can monitor people from home and judge if and when they need to be admitted to hospital.”

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