Sistema d'Emergències Mèdiques de Catalunya, España. Grupo RINVEMER. Red de Investigación de Emergencias Prehospitalarias.
Servei d'Urgències Hospital Universitari de Bellvitge, Barcelona, España.
Emergencias. 2022 Feb;34(1):29-37.
To develop and validate a triage scale (Spanish acronym, TIHCOVID) to assign priority by predicting critical events in patients with severe COVID-19 who are candidates for interhospital transfer.
Prospective cohort study in 2 periods for internal (February-April 2020) and external (October-December 2020) validation. We included consecutive patients with severe COVID-19 who were transported by the emergency medical service of Catalonia. A risk model was developed to predict mortality based on variables recorded on first contact between the regional emergency coordination center and the transferring hospital. The model's performance was evaluated by means of calibration and discrimination, and the results for the first and second periods were compared.
Nine hundred patients were included, 450 in each period. In-hospital mortality was 33.8%. The 7 predictors included in the final model were age, comorbidity, need for prone positioning, renal insufficiency, use of high-flow nasal oxygen prior to mechanical ventilation, and a ratio of PaO2 to inspired oxygen fraction of less than 50. The performance of the model was good (Brier score, 0.172), and calibration and discrimination were consistent. We found no significant differences between the internal and external validation steps with respect to either the calibration slopes (0.92 [95% CI, 0.91-0.93] vs 1.12 [95% CI, 0.6-1.17], respectively; P = .150) or discrimination (area under the curve, 0.81 [95% CI, 0.75-0.84] vs 0.85 [95% CI, 0.81-0.89]; P = .121).
The TIHCOVID tool may be useful for triage when assigning priority for patients with severe COVID-19 who require transfer between hospitals.
开发并验证一个分诊量表（西班牙语首字母缩写 TIHCOVID），通过预测因严重 COVID-19 而需要院内转院的患者的危急事件，为患者分配优先级。
这是一项前瞻性队列研究，分为两个时期进行，内部验证期为 2020 年 2 月至 4 月，外部验证期为 2020 年 10 月至 12 月。我们纳入了由加泰罗尼亚紧急医疗服务转运的连续严重 COVID-19 患者。基于区域紧急协调中心与转运医院首次联系时记录的变量，建立了一个预测死亡率的风险模型。通过校准和区分度评估模型的性能，并比较了第一和第二期的结果。
共纳入 900 例患者，每期各 450 例。院内死亡率为 33.8%。最终模型纳入的 7 个预测因子包括年龄、合并症、需要俯卧位、肾功能不全、在机械通气前使用高流量鼻氧、以及 PaO2 与吸入氧分数比值＜50。模型的性能良好（Brier 评分 0.172），校准和区分度一致。我们未发现内部和外部验证步骤在校准斜率（分别为 0.92 [95%CI，0.91-0.93]和 1.12 [95%CI，0.6-1.17]）或区分度（曲线下面积，分别为 0.81 [95%CI，0.75-0.84]和 0.85 [95%CI，0.81-0.89]）方面存在显著差异（P =.150）。
TIHCOVID 工具可用于为需要院内转院的严重 COVID-19 患者分配优先级时进行分诊。
