Department of Translational Medicine, Eastern Piedmont University, Novara, Italy -
Emergency Department, Maggiore della Carità University Hospital, Novara, Italy -
Minerva Med. 2021 Feb;112(1):118-123. doi: 10.23736/S0026-4806.20.07074-3. Epub 2020 Oct 26.
The Novara-COVID score was developed to help the emergency physician to decide which Coronavirus disease (COVID) patient required hospitalization at Emergency Department (ED) presentation and to which intensity of care. We aimed at evaluating its prognostic role.
We retrospectively collected data of COVID patients admitted to our ED between March 16 and April 22, 2020. The Novara-COVID score was systematically applied to all COVID patients since its introduction in clinical practice and adopted to decide patients' destination. The ability of the Novara-COVID score to predict in-hospital clinical stability and in-hospital mortality were evaluated through multivariable logistic regression and cox regression hazard models, respectively.
Among the 480 COVID patients admitted to the ED, 338 were hospitalized: the Novara-COVID score was 0-1 in 49.7%, 2 in 24.6%, 3 in 15.4% and 4-5 in 10.3% of patients. Novara-COVID score values of 3 and 4-5 were associated with lower clinical stability with adjusted odds ratios of 0.28 (0.13-0.59) and 0.03 (0.01-0.12), respectively. When in-hospital mortality was evaluated, a significant difference emerged between scores of 0-1 and 2 vs. 3 and 4-5. In particular, the death adjusted hazard ratio for Novara-COVID scores of 3 and 4-5 were 2.6 (1.4-4.8) and 8.4 (4.7-15.2), respectively.
The Novara-COVID score reliably predicts in-hospital clinical instability and mortality of COVID patients at ED presentation. This tool allows the emergency physician to detect patients at higher risk of clinical deterioration, suggesting a more aggressive therapeutic management from the beginning.
Novara-COVID 评分旨在帮助急诊医生决定哪些冠状病毒病（COVID）患者在急诊科就诊时需要住院治疗以及需要何种强度的治疗。我们旨在评估其预后作用。
我们回顾性收集了 2020 年 3 月 16 日至 4 月 22 日期间在我院急诊科收治的 COVID 患者的数据。自临床实践中引入 Novara-COVID 评分以来，我们系统地对所有 COVID 患者应用了该评分，并采用该评分来决定患者的去向。通过多变量逻辑回归和 Cox 回归风险模型分别评估了 Novara-COVID 评分对住院期间临床稳定性和住院死亡率的预测能力。
在急诊科收治的 480 例 COVID 患者中，有 338 例住院治疗：Novara-COVID 评分为 0-1 的患者占 49.7%，2 分的患者占 24.6%，3 分的患者占 15.4%，4-5 分的患者占 10.3%。3 分和 4-5 分的 Novara-COVID 评分与较低的临床稳定性相关，调整后的优势比分别为 0.28（0.13-0.59）和 0.03（0.01-0.12）。评估住院死亡率时，0-1 分和 2 分与 3 分和 4-5 分之间存在显著差异。特别是，Novara-COVID 评分 3 分和 4-5 分的死亡调整风险比分别为 2.6（1.4-4.8）和 8.4（4.7-15.2）。
Novara-COVID 评分可靠地预测了 COVID 患者在急诊科就诊时的住院临床不稳定和死亡率。该工具使急诊医生能够发现临床恶化风险较高的患者，从而从一开始就建议进行更积极的治疗管理。
