RAPID score in Covid-19 patients: a clinical-radiological index for the safe discharge from the Emergency Department. A preliminary report

  • Filippo Vaccher | f.vaccher@unibs.it Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia; Radiologia 2, ASST Spedali Civili di Brescia, Italy.
  • Ciro Paolillo Emergency Department, ASST Spedali Civili di Brescia, Brescia, Italy.
  • Nunzia Di Meo Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia; Radiologia 2, ASST Spedali Civili di Brescia, Italy.
  • Marco Ramanzin Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia; Radiologia 2, ASST Spedali Civili di Brescia, Italy.
  • Marco Ravanelli Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia; Radiologia 2, ASST Spedali Civili di Brescia, Italy.
  • Roberto Maroldi Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia; Radiologia 2, ASST Spedali Civili di Brescia, Italy.
  • Davide Farina Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia; Radiologia 2, ASST Spedali Civili di Brescia, Italy.

Abstract

To evaluate the performance of a clinical-radiological index (RAPID-Covid score) in achieving Safe Discharge (SD) of patients accessing the Emergency Department (ED) with symptoms suggesting Covid-19. Clinical and radiological data were retrospectively collected from 853 consecutive patients admitted to the ED during the pandemics with symptoms suggesting Covid-19. Illness severity was graded with RAPID-Covid score, composed of chest X-ray findings, clinical symptoms and PaO2/FiO2. Patients with RAPIDCovid score ≥5 were admitted. Primary outcome was SD of patients to home care. SD was defined as survival of the patient, without evidence of second access to ED requiring hospitalization. 212/853 patients were discharged. 27/212 had a score ≥5 but refused admission. 185/212 were discharged with score <5: 147/185 (79,5%) survived and did not re-access ED; 1/185 (0,5%) died at home after first ED-dismissal; 37/185 (20,0%) had a second access. Of these 15/37 (8,1%) were newly dismissed and one of them (1/15) died at home; 22/37 (11,9%) were hospitalized, 1/22 died during hospitalization. SD was obtained in 161/185 patients (87%). Readmissions occurred 5,1±2,6days from first discharge. Follow-up was 16,7±6,0days. RAPID-Covid score proves useful for SD of Covid-19 to home care. 6-10days may further increase confidence.

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Published
2020-12-23
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Original Articles
Keywords:
Covid-19, triage, score, RAPID-Covid score, Chest X-Ray
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How to Cite
Vaccher, F., Paolillo, C., Di Meo, N., Ramanzin, M., Ravanelli, M., Maroldi, R., & Farina, D. (2020). RAPID score in Covid-19 patients: a clinical-radiological index for the safe discharge from the Emergency Department. A preliminary report. Emergency Care Journal, 16(3). https://doi.org/10.4081/ecj.2020.9192