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The Comorbidities, Radiographic Findings, Age, and Lymphopenia (CORAL) Tool: A Diagnostic Ally for Emergency
Carlos Castro-Vásquez1, Michelle Bass2, Gustavo Díaz3
1Department of Emergency Medicine, Trinity Health Livonia Hospital, Michigan State University College of Osteopathic Medicine, Livonia, USA.
Insights
A new CORAL tool predicts intensive care unit (ICU) admission and mortality in COVID-19 patients using age, comorbidities, lymphopenia, and imaging. This practical approach aids emergency physicians globally.
Area of Science:
- Emergency Medicine
- Critical Care
- Infectious Diseases
Background:
- Coronavirus disease 2019 (COVID-19) poses a significant challenge in emergency departments (EDs).
- Predicting intensive care unit (ICU) admission and mortality is crucial for effective patient management.
- Novel clinical tools are needed to stratify COVID-19 patients at risk.
Purpose of the Study:
- To develop and validate a novel clinical approach for predicting ICU admission and mortality in COVID-19 patients presenting to the ED.
- To identify key clinical, laboratory, and imaging predictors of adverse outcomes in COVID-19.
Main Methods:
- Retrospective cohort study of 808 adult COVID-19 patients admitted to the ED.
- Logistic regression models were used to identify predictors of mortality and ICU admission.
- Variables included demographics, comorbidities, symptom phenotype, laboratory (lymphopenia), and imaging findings.
Main Results:
- Age ≥ 60 years, chronic obstructive pulmonary disease (COPD), lymphopenia, and imaging findings were associated with mortality.
- Age ≥ 60 years, lymphopenia (<1,000 cells/µL), and hypothyroidism predicted ICU admission.
- These factors were integrated into the Comorbidities, Radiographic findings, Age, and Lymphopenia (CORAL) tool.
Conclusions:
- The CORAL tool provides a practical method for predicting COVID-19 patient outcomes in the ED.
- It is valuable in diverse clinical settings, including resource-limited areas.
- The tool supports emergency physicians in risk stratification and clinical decision-making.
Background:
This study aimed to develop a novel clinical approach to predict intensive care unit (ICU) admission and mortality among coronavirus disease 2019 (COVID-19) patients in the emergency department (ED).
Methods:
A retrospective cohort study was conducted including adults ≥ 18 years diagnosed with COVID-19 in the emergency department and admitted to the ICU between March and July 2020 in an academic hospital. The outcome variables were mortality and ICU admission. Additional variables that were collected included sex, age, comorbidities, symptom phenotype, and laboratory (lymphopenia) and imaging findings. A logistic regression model was used to construct and validate the risk models.
Results:
A total of 808 patients were included in the study; 61.9% were men. The mean age was 57.8 ± 15.9 years, and high blood pressure (HBP) was the most prevalent comorbidity (31.8%). Seventy-six (9.4%) patients were admitted to the ICU. Age ≥ 60 years, chronic obstructive pulmonary disease (COPD), lymphopenia, and imaging findings correlated with mortality. Age ≥ 60 years, lymphopenia (<1,000 cells per microliter), and hypothyroidism correlated with ICU admission. These variables were incorporated into a scoring system (Comorbidities, Radiographic findings, Age, and Lymphopenia (CORAL) tool) to predict mortality and ICU admission.
Conclusions:
Our Comorbidities, Radiographic findings, Age, and Lymphopenia (CORAL) tool is a practical tool for different clinical settings independent of access to advanced medical resources or technologies. CORAL is suitable for emergency physicians in low- and middle-income countries.
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