A simple tool to help ruling-out Covid-19 in the emergency department: derivation and validation of the LDH-CRP-Lymphocyte (LCL) score

  • Jacopo Davide Giamello | jacopo.giamello@gmail.com School of Emergency Medicine, University of Turin, Turin, Italy.
  • Giulia Paglietta School of Emergency Medicine, University of Turin, Italy.
  • Giulia Cavalot Department of Emergency Medicine, Santa Croce and Carle Hospital, Cuneo, Italy.
  • Attilio Allione Department of Emergency Medicine, Santa Croce and Carle Hospital, Cuneo, Italy.
  • Sara Abram Department of Emergency Medicine, Santa Croce and Carle Hospital, Cuneo, Italy.
  • Luca Dutto Department of Emergency Medicine, Santa Croce and Carle Hospital, Cuneo, Italy.
  • Sara Bernardi Department of Emergency Medicine, Santa Croce and Carle Hospital, Cuneo, Italy.
  • Emanuele Bernardi Department of Emergency Medicine, Santa Croce and Carle Hospital, Cuneo, Italy.
  • Francesco Tosello Department of Emergency Medicine, Santa Croce and Carle Hospital, Cuneo, Italy.
  • Giuseppe Lauria Department of Emergency Medicine, Santa Croce and Carle Hospital, Cuneo, Italy.

Abstract

After the outbreak of the Covid-19 pandemic, cases of SARSCoV- 2 infections may gradually decrease in the next months. Given the reduced prevalence of the disease, Emergency Departments (ED) are starting to receive more and more non- Covid19 patients. Thus, a way to quickly discriminate ED patients with potential Covid-19 infection from non-Covid19 patients is needed in order to keep potentially contagious patients isolated while awaiting second-level testing. In this paper, we present the derivation and validation of a simple, practical, and cheap score that could be helpful to rule out Covid-19 among ED patients with suspicious symptoms (fever and/or dyspnoea). The LCL score was derived from a cohort of 335 patients coming to the ED of our hospital from March 16th to April 1st, 2020. It was then retrospectively validated in a similar cohort of 173 patients admitted to our ED during April. The score is based on blood values of lactate dehydrogenase, C-reactive protein, and lymphocyte count. The LCL score performed well both in the derivation and in the validation cohort, with an AUC respectively of 0.81 (95% CI: 0.77 – 0.86) and of 0.71 (95% CI: 0.63 – 0.78), given the difference in Covid- 19 prevalence between the two cohorts (57% vs 41% respectively). An LCL score equal to 0 had a negative predictive value of 0.92 in the derivation cohort and of 0.81 in the validation cohort, with a negative likelihood ratio respectively of 0.08 and 0.36 for Covid- 19 exclusion. This score could, therefore, constitute a useful tool to help physicians manage patients in the ED.

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Published
2020-12-23
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Original Articles
Keywords:
Covid-19, prognostic score, emergency department
Statistics
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How to Cite
Giamello, J. D., Paglietta, G., Cavalot, G., Allione, A., Abram, S., Dutto, L., Bernardi, S., Bernardi, E., Tosello, F., & Lauria, G. (2020). A simple tool to help ruling-out Covid-19 in the emergency department: derivation and validation of the LDH-CRP-Lymphocyte (LCL) score. Emergency Care Journal, 16(3). https://doi.org/10.4081/ecj.2020.9336