New tool to help hospital staff treat coronavirus patients

Researchers identified the groups using clinical information and tests carried out on arrival at hospital to predict the patients’ risk of death – ranging from low to very high.

An identification tool – the most accurate to date – has been designed using the groupings to help clinical staff choose the best course of treatment for patients.

The tool was built by the ISARIC Coronavirus Clinical Characterisation Consortium involving researchers from the Universities of Edinburgh, Glasgow, Liverpool and Imperial College London.

They used data from 35,000 patients admitted to hospital between February and May who met the criteria for one of the four groups.

The tool was then tested for accuracy using data from a further 22,000 patients hospitalised from the end of May to the end of June.

Professor Ewen Harrison, senior author and professor of surgery and data science at the University of Edinburgh, said: “As doctors, we want to identify groups of patients most at risk of dying from Covid-19.

“If we can do that at the front door of the hospital, then treatment can be better planned. This easy-to-use tool will help doctors make decisions to provide patients with the optimal care.”

Some of the data used to identify which group a person falls into and, therefore, their risk of dying included age, sex, the number of pre-existing conditions, respiratory rate on admission and the results of two blood tests.

One in every 100 patients in the low-risk group was found to be at risk of dying; 10 in 100 patients in the intermediate-risk group; 31 in 100 in the high-risk group and 62 in 100 in the very high-risk group.

The categorisations make new treatments possible. For example, it might be more appropriate for those who fall into the low-risk subgroup to be treated at home.

People in the high or very high risk groups could benefit from more aggressive treatment, such as the use of antivirals and early admission to critical care.

Dr Antonia Ho, co-lead author clinical senior lecturer and consultant in infectious diseases at the University of Glasgow, said: “This simple tool will help doctors at the front door to make informed decisions on how to manage patients with Covid-19.

“It will allow targeting of early treatment and admission to critical care in patients at high risk of dying and, conversely, identify low-risk patients who may be safely managed at home.”

Until now there has not been an accurate risk tool for Covid-19 patients.

However, it does have one limitation – it can only be used on hospital patients and not in the community.

For the full study findings visit www.bmj.com/content/370/bmj.m3339.