scholarly journals CCEDRRN COVID-19 Infection Score (CCIS): development and validation in a Canadian cohort of a clinical risk score to predict SARS-CoV-2 infection in patients presenting to the emergency department with suspected COVID-19

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e055832
Author(s):  
Andrew D McRae ◽  
Corinne M Hohl ◽  
Rhonda Rosychuk ◽  
Shabnam Vatanpour ◽  
Gelareh Ghaderi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Nucleic Acid ◽  
Risk Score ◽  
Emergency Departments ◽  
Disease Incidence ◽  
Empirical Therapy ◽  
Superior Performance ◽  
Clinical Risk Score ◽  
Clinical Risk ◽  
Test Result

ObjectivesTo develop and validate a clinical risk score that can accurately quantify the probability of SARS-CoV-2 infection in patients presenting to an emergency department without the need for laboratory testing.DesignCohort study of participants in the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) registry. Regression models were fitted to predict a positive SARS-CoV-2 test result using clinical and demographic predictors, as well as an indicator of local SARS-CoV-2 incidence.Setting32 emergency departments in eight Canadian provinces.Participants27 665 consecutively enrolled patients who were tested for SARS-CoV-2 in participating emergency departments between 1 March and 30 October 2020.Main outcome measuresPositive SARS-CoV-2 nucleic acid test result within 14 days of an index emergency department encounter for suspected COVID-19 disease.ResultsWe derived a 10-item CCEDRRN COVID-19 Infection Score using data from 21 743 patients. This score included variables from history and physical examination and an indicator of local disease incidence. The score had a c-statistic of 0.838 with excellent calibration. We externally validated the rule in 5295 patients. The score maintained excellent discrimination and calibration and had superior performance compared with another previously published risk score. Score cut-offs were identified that can rule-in or rule-out SARS-CoV-2 infection without the need for nucleic acid testing with 97.4% sensitivity (95% CI 96.4 to 98.3) and 95.9% specificity (95% CI 95.5 to 96.0).ConclusionsThe CCEDRRN COVID-19 Infection Score uses clinical characteristics and publicly available indicators of disease incidence to quantify a patient’s probability of SARS-CoV-2 infection. The score can identify patients at sufficiently high risk of SARS-CoV-2 infection to warrant isolation and empirical therapy prior to test confirmation while also identifying patients at sufficiently low risk of infection that they may not need testing.Trial registration numberNCT04702945.

scholarly journals Development and validation of a clinical risk score to predict SARS-CoV-2 infection in emergency department patients: The CCEDRRN COVID-19 Infection Score (CCIS)

2021 ◽  
Author(s):  
Andrew D. McRae ◽  
Corinne M. Hohl ◽  
Rhonda J. Rosychuk ◽  
Shabnam Vatanpour ◽  
Gelareh Ghaderi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Risk Score ◽  
Health Research ◽  
Disease Incidence ◽  
Empiric Therapy ◽  
Health Science ◽  
Superior Performance ◽  
Manuscript Preparation ◽  
Continuous Variables ◽  
Derivation Cohort

Background Clinicians face decisions around the need for severe acute respiratory coronavirus 2 (SARS-CoV-2) testing, patient isolation, and empiric therapy when patients arrive in acute care hospitals. Our objective was to develop a risk score that can accurately quantify a patient's probability of SARS-CoV-2 infection. Methods This observational study enrolled consecutive adults who presented to the emergency departments of 32 hospitals participating in Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) and were tested for SARS-CoV-2. We divided our study population by randomly assigning study sites into derivation (75%) and validation (25%) cohorts. We pre-specified predictors and used multiple imputation for variables with incomplete data. In the derivation cohort, we fit models using logistic regression, with spline functions for continuous variables, to predict the primary outcome of a positive SARS-CoV-2 nucleic acid test. We used a fast step-down procedure to select a concise model. The final reduced model had points allocated to each variable based on their predictive strength. We then validated the model in the geographically distinct validation cohort. Findings We derived a ten-item CCEDRRN COVID-19 Infection Score using data from 21,743 patients. This score included variables from history and physical examination, and an indicator of local disease incidence. The score had a C-statistic of 0.838 with excellent calibration. We externally validated the rule in 5,295 patients. The score maintained excellent discrimination and calibration, and had superior performance compared to another previously published risk score. Interpretation The CCEDRRN COVID-19 Infection Score uses clinical characteristics and publicly available indicators of disease incidence to quantify a patient's probability of SARS-CoV-2 infection. The score can identify patients at sufficiently high risk of SARS-CoV-2 infection to warrant isolation and empiric therapy prior to test confirmation, while also identifying patients at sufficiently low risk of infection that they may not need testing. Funding The network is funded by the Canadian Institutes of Health Research (447679), BC Academic Health Science Network Society, BioTalent Canada, Genome BC (COV024; VAC007), Ontario Ministry of Colleges and Universities (C-655-2129), the Saskatchewan Health Research Foundation (5357) and the Fondation CHU de Quebec (Octroi #4007). These organizations are not-for-profit, and had no role in study conduct, analysis, or manuscript preparation.

scholarly journals Early mortality in prophylactic implantable cardioverter-defibrillator recipients: development and validation of a clinical risk score

EP Europace ◽  
2013 ◽  
Vol 16 (1) ◽  
pp. 40-46 ◽  
Author(s):  
K. Kraaier ◽  
M. F. Scholten ◽  
J. G. P. Tijssen ◽  
D. A. M. J. Theuns ◽  
L. J. L. M. Jordaens ◽  
...  
Keyword(s):  
Implantable Cardioverter Defibrillator ◽  
Risk Score ◽  
Early Mortality ◽  
Clinical Risk Score ◽  
Cardioverter Defibrillator ◽  
Clinical Risk ◽  
Development And Validation

scholarly journals Erratum to: Development of a clinical risk score for pain and function following total knee arthroplasty: results from the TRIO study

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Joanna Shim ◽  
David J Mclernon ◽  
David Hamilton ◽  
Hamish A Simpson ◽  
Marcus Beasley ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Risk Score ◽  
Knee Arthroplasty ◽  
Clinical Risk Score ◽  
Clinical Risk ◽  
Total Knee ◽  
And Function

scholarly journals SARS-CoV-2 sample-to-answer nucleic acid testing in a tertiary care emergency department: evaluation and utility

2020 ◽  
Author(s):  
Pia Jokela ◽  
Anu E Jääskeläinen ◽  
Hanna Jarva ◽  
Tanja Holma ◽  
Maarit J Ahava ◽  
...  
Keyword(s):  
Nucleic Acid ◽  
Emergency Departments ◽  
Large Scale ◽  
Tertiary Care ◽  
Reference Method ◽  
Preliminary Evaluation ◽  
Specificity And Sensitivity ◽  
Department Evaluation ◽  
Test Result ◽  
Respiratory Specimens

AbstractRapid sample-to-answer tests for detection of SARS-CoV-2 are emerging and data on their relative performance is urgently needed. We evaluated the analytical performance of two rapid nucleic acid tests, Cepheid Xpert® Xpress SARS-CoV-2 and Mobidiag Novodiag® Covid-19, in comparison to a combination reference of three large-scale PCR tests. Moreover, utility of the Novodiag® test in tertiary care emergency departments was assessed. In the preliminary evaluation, analysis of 90 respiratory samples resulted in 100% specificity and sensitivity for Xpert®, whereas analysis of 107 samples resulted in 93.4% sensitivity and 100% specificity for Novodiag®. Rapid SARS-CoV-2 testing with Novodiag® was made available for four tertiary care emergency departments in Helsinki, Finland between 18 and 31 May, coinciding with a rapidly declining epidemic phase. Altogether 361 respiratory specimens, together with relevant clinical data, were analyzed with Novodiag® and reference tests: 355/361 of the specimens were negative with both methods, and 1/361 was positive in Novodiag® and negative by the reference method. Of the 5 remaining specimens, two were negative with Novodiag®, but positive with the reference method with late Ct values. On average, a test result using Novodiag® was available nearly 8 hours earlier than that obtained with the large-scale PCR tests. While the performance of novel sample-to-answer PCR tests need to be carefully evaluated, they may provide timely and reliable results in detection of SARS-CoV-2 and thus facilitate patient management including effective cohorting.

scholarly journals Predicting risk of COPD in primary care: development and validation of a clinical risk score

2015 ◽  
Vol 2 (1) ◽  
pp. e000060 ◽  
Author(s):  
Shamil Haroon ◽  
Peymane Adab ◽  
Richard D Riley ◽  
Tom Marshall ◽  
Robert Lancashire ◽  
...  
Keyword(s):  
Primary Care ◽  
Risk Score ◽  
Clinical Risk Score ◽  
Clinical Risk ◽  
Development And Validation ◽  
Care Development

Abstract 2311: Clinical Predictors Of Survival In Heart Failure Patients Following Cardiac Resynchronization Therapy

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Daniel M Couri ◽  
Grace Lin ◽  
Tracy L Webster ◽  
Peter A Brady
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Multivariate Analysis ◽  
Cardiac Resynchronization Therapy ◽  
Risk Score ◽  
Ischemic Cardiomyopathy ◽  
Cardiac Resynchronization ◽  
Clinical Risk Score ◽  
Resynchronization Therapy ◽  
Clinical Risk

Introduction: Appropriate selection of patients (pts) with heart failure (HF) who may benefit from cardiac resynchronization therapy (CRT) is difficult. We sought to identify a clinical risk score to better risk stratify patients prior to CRT implantation. Methods: Pts undergoing CRT at Mayo Clinic from 2000 –2005 were included. Multiple clinical variables (age, gender, anemia (Hgb <10g/dL), RF (creatinine clearance ≤ 60ml/min/1.73m 2 ), hyponatremia (Na ≤130mEq/L), elevated BNP level (>500pg/ml), etiology, EF ≤20%, and advanced HF (NYHA functional class III–IV) were assessed with outcomes following CRT. Multivariate analysis was used to determine a clinical risk score. Results: A total of 496 patients (80% males) age 68 ± 12 years (62% ischemic cardiomyopathy, EF 22% ± 8%) were included. In univariate analysis relative risk (RR) was > 1 for RF (RR 1.8, CI 1.3–2.8; p = 0.002), anemia (RR 3.3, CI 1.8 –5.5; p = 0.001), hyponatremia (RR 3.4, CI 1.4 – 6.9; p = 0.008), elevated BNP (RR 2.9, CI 1.6 –5.7; p < 0.001), ischemic cardiomyopathy (ICM) (RR 1.8, CI 1.2–2.7; p < 0.002), EF ≤ 20% (RR 1.5, CI 1.0 –2.1; p = 0.033), and advanced HF (RR 2.5, CI 1.5– 4.9; p < 0.001). Following multivariate analysis RF, anemia, ICM, and advanced HF remained significant predictors of poor outcome (p >0.01 for all). Survival with 3 or more of these clinical risk factors was significantly worse than with less risk factors (p <0.01, Figure ). Conclusions: Pre-implant clinical risk factors including anemia, RF, ICM and advanced HF predict worse outcome following CRT with ≥3 variables predicting >2-fold increased risk of death or heart transplantation. These factors should be considered when selecting pts prior to CRT.

Abstract 14206: Assessing a Clinical Risk Score and the Impact of Race in Breast Cancer Patients at Risk of Cardiotoxicity

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Zachary Brumberger ◽  
Mary Branch ◽  
Joseph Rigdon ◽  
Suji Vasu
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Risk Score ◽  
Significant Risk ◽  
Statistical Characteristics ◽  
Risk Scores ◽  
Clinical Risk Score ◽  
Breast Cancer Patients ◽  
Clinical Risk ◽  
The Impact

Introduction: Cardiotoxicity is a well-known risk in breast cancer patients treated with anthracyclines and trastuzumab. Ezaz et al. developed a clinical risk score (CRS) to risk stratify these patients. Despite evidence that African American (AA) race is a significant risk factor for cardiotoxicity, no study has assessed the impact of AA race on this CRS. Here we assess the discrimination ability of the Ezaz et al. CRS with the addition of AA race. Methods: This is a retrospective cohort utilizing a registry of 118 patients with stage I-IV breast cancer treated with anthracyclines and/or trastuzumab. Patients without baseline echocardiography data or with baseline LVEF < 50% were excluded. The CRS from Ezaz et al. consisting of age, adjuvant chemotherapy, coronary artery disease, atrial fibrillation or flutter, diabetes mellitus, hypertension, and renal failure was calculated with the addition of AA race. Cardiotoxicity was defined by an LVEF decline of ≥ 10% to LVEF < 53% from baseline. Results: In our 118 patient cohort, the mean age was 59 years, 23 (20%) AA patients, 65 (55%) patients considered low risk (scores of 0-3) and 53 (45%) considered moderate to high risk (scores ≥4). After a follow up of 3 months to 5 years, 14 (12%) patients developed cardiotoxicity. Table 1 lists the CRS changes in statistical characteristics and predictability with the addition of AA race. In comparing the models, the AUC c-statistic increased from 0.609 to 0.642 (95% CI 0.47-0.75, 95% CI 0.49-0.79 respectively; P value = 0.56) with the addition of AA race ( Figure 1 ). Conclusions: In this study, the Ezaz et al. CRS demonstrated improved discrimination and sensitivity with the addition of AA race. This study suggests AA race improves the predictive ability of the Ezaz et al. CRS. Given the limited size of our study, we promote that this should be hypothesis-driving and encourage further investigation on the path to develop an important risk stratification tool.

Sign in / Sign up

Export Citation Format

Share Document