Background The HOME-CoV (Hospitalisation or Outpatient ManagEment of patients with SARS-CoV-2 infection) score is a validated list of uniquely clinical criteria indicating which patients with probable or proven COVID-19 can be treated at home. The aim of this study was to optimise the score to improve its ability to discriminate between patients who do and do not need admission. Methods A revised HOME-CoV score was derived using data from a previous prospective multicentre study which evaluated the original Home-CoV score. Patients with proven or probable COVID-19 attending 34 EDs in France, Monaco and Belgium between April and May 2020 were included. The population was split into a derivation and validation sample corresponding to the observational and interventional phases of the original study. The main outcome was non-invasive or invasive ventilation or all-cause death within 7 days following inclusion. Two threshold values were defined using a sensitivity of >0.9 and a specificity of >0.9 to identify low-risk and high-risk patients, respectively. The revised HOME-CoV score was then validated by retrospectively applying it to patients in the same EDs with proven or probable COVID-19 during the interventional phase. The revised HOME-CoV score was also tested against original HOME-CoV, qCSI, qSOFA, CRB65 and SMART-COP in this validation cohort. Results There were 1696 patients in the derivation cohort, of whom 65 (3.8%) required non-invasive ventilation or mechanical ventilation or died within 7 days and 1304 patients in the validation cohort, of whom 22 (1.7%) had a progression of illness. The revised score included seven clinical criteria. The area under the curve (AUC) was 87.6 (95% CI 84.7 to 90.6). The cut-offs to define low-risk and high-risk patients were <2 and >3, respectively. In the validation cohort, the AUC was 85.8 (95% CI 80.6 to 91.0). A score of <2 qualified 73% of patients as low risk with a sensitivity of 0.77 (0.55–0.92) and a negative predictive value of 0.99 (0.99–1.00). Conclusion The revised HOME-CoV score, which does not require laboratory testing, may allow accurate risk stratification and safely qualify a significant proportion of patients with probable or proven COVID-19 for home treatment. Data are available upon reasonable request.

中文翻译：

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急诊室中疑似或确诊的 COVID-19 患者的风险分层模型的推导和验证：修订后的 HOME-CoV 评分

背景 HOME-CoV（SARS-CoV-2 感染患者的住院或门诊管理）评分是经过验证的独特临床标准列表，表明哪些可能患有或已确诊感染 COVID-19 的患者可以在家接受治疗。本研究的目的是优化评分，以提高其区分需要和不需要入院的患者的能力。方法 使用先前评估原始 Home-CoV 评分的前瞻性多中心研究的数据得出修订后的 HOME-CoV 评分。 2020 年 4 月至 5 月期间在法国、摩纳哥和比利时 34 家急诊室就诊的确诊或疑似 COVID-19 患者被纳入其中。将人群分为对应于原始研究的观察和干预阶段的推导样本和验证样本。主要结局是纳入后 7 天内无创或有创通气或全因死亡。使用 >0.9 的敏感性和 >0.9 的特异性定义两个阈值，分别识别低风险和高风险患者。然后，通过回顾性地将修订后的 HOME-CoV 评分应用于干预阶段期间确诊或可能感染 COVID-19 的同一急诊室的患者来进行验证。在此验证队列中，还针对原始 HOME-CoV、qCSI、qSOFA、CRB65 和 SMART-COP 测试了修订后的 HOME-CoV 评分。结果 推导队列中有 1696 名患者，其中 65 名（3.8%）需要无创通气或机械通气或在 7 天内死亡；验证队列中有 1304 名患者，其中 22 名（1.7%）病情进展。修订后的评分包括七项临床标准。曲线下面积 (AUC) 为 87.6（95% CI 84.7 至 90.6）。定义低风险和高风险患者的临界值分别为<2和>3。在验证队列中，AUC 为 85.8（95% CI 80.6 至 91.0）。评分 <2 表明 73% 的患者属于低风险，敏感性为 0.77 (0.55–0.92)，阴性预测值为 0.99 (0.99–1.00)。结论 修订后的 HOME-CoV 评分不需要实验室检测，可以实现准确的风险分层，并安全地使很大一部分疑似或已确诊的 COVID-19 患者接受家庭治疗。数据可根据合理要求提供。