A 4C mortality score based dichotomic rule supports Emergency Department discharge of COVID-19 patients

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Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure

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Fulvio Morello1,2, Paolo Bima3,4, Jacopo D Giamello3,5

  • 1Emergency Medicine U Unit, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy - fulvio.morello@unito.it.

Minerva Medica
|February 22, 2022
PubMed

Insights

The 4C mortality score (4CMS) can safely identify mild COVID-19 cases for emergency department discharge. A score of 8 or less indicates low risk, allowing safe home disposition for these patients.

Area of Science:

  • Emergency Medicine
  • Infectious Diseases
  • Clinical Prognostication

Background:

  • Emergency Department (ED) disposition for COVID-19 patients is challenging.
  • The 4C mortality score (4CMS) is a validated tool for COVID-19 inpatients.
  • A need exists for a tool to identify mild COVID-19 cases for safe ED discharge.

Purpose of the Study:

  • To derive and validate a simple rule using the 4CMS.
  • To identify COVID-19 patients with mild outcomes suitable for safe ED discharge.
  • To assess the 4CMS's performance against other scores and Chest X-ray (CXR).

Main Methods:

  • Derivation in a prospective cohort of 838 ED patients with suspected COVID-19.
  • Validation in a prospective multicenter cohort of 521 ED patients with confirmed COVID-19.
  • Primary outcome: 30-day mortality or hospital admission; Secondary outcomes: ED re-visit, oxygen therapy, ventilation.

Main Results:

  • A 4CMS cutoff of ≤8 was associated with low outpatient mortality (0.4%) in the derivation cohort.
  • In the validation cohort, 4CMS outperformed other scores and CXR for the primary outcome (AUC 0.82) and mortality (AUC 0.93).
  • For 4CMS≤8 (91% of patients), mortality was 0.2% and hospital admission was 6.8%, versus 12.8% and 36.2% for 4CMS≥9 (P<0.001).

Conclusions:

  • COVID-19 outpatients with a 4CMS score of 8 or less experience mild outcomes.
  • These patients can be safely discharged from the Emergency Department.
  • The 4CMS provides a reliable tool for ED disposition decisions in COVID-19 patients.
Abstract

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