Development and Validation of Simple Risk Scores to Predict Hospitalization in Outpatients with COVID-19 Including the Omicron Variant

Mark H Ebell; Roya Hamadani; Autumn Kieber-Emmons

doi:10.3122/jabfm.2022.AP.220056

Development and Validation of Simple Risk Scores to Predict Hospitalization in Outpatients with COVID-19 Including the Omicron Variant

J Am Board Fam Med. 2022 Sep 16:jabfm.2022.AP.220056. doi: 10.3122/jabfm.2022.AP.220056. Online ahead of print.

Authors

Mark H Ebell¹, Roya Hamadani², Autumn Kieber-Emmons²

Affiliations

¹ From Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, (MHE); University of South Florida Morsani College of Medicine, Lehigh Valley Health Network, Allentown, PA (RH, AKE). ebell@uga.edu.
² From Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, (MHE); University of South Florida Morsani College of Medicine, Lehigh Valley Health Network, Allentown, PA (RH, AKE).

PMID: 36113996
DOI: 10.3122/jabfm.2022.AP.220056

Abstract

Outpatient physicians need guidance to support decisions regarding hospitalization of COVID-19 patients and how closely to follow outpatients. Thus, we sought to develop and validate simple risk scores to predict hospitalization for outpatients with COVID-19 that do not require laboratory testing or imaging. METHODS: We identified outpatients 12 years and older who had a positive polymerase chain reaction test for SARS-CoV-2. Logistic regression was used to derive a risk score in patients presenting before March, 2021, and it was validated in a cohort presenting from March to September 2021 and an Omicron cohort from December, 2021 to January, 2022. RESULTS: Overall, 4.0% of 5843 outpatients in the early derivation cohort (before 3/1/21), 4.2% of 3806 outpatients in the late validation cohort, and 1.2% in an Omicron cohort were hospitalized. The base risk score included age, dyspnea, and any comorbidity. Other scores added fever, respiratory rate and/or oxygen saturation. All had very good overall accuracy (AUC 0.85-0.87) and classified about half of patients into a low-risk group with < 1% hospitalization risk. Hospitalization rates in the Omicron cohort were 0.22%, 1.3% and 8.7% for the base score. Two externally derived risk scores identified more low risk patients, but with a higher overall risk of hospitalization than our novel risk scores. CONCLUSIONS: A simple risk score suitable for outpatient and telehealth settings can classify over half of COVID-19 outpatients into a very low risk group with a 0.22% hospitalization risk in the Omicron cohort. The Lehigh Outpatient COVID Hospitalization (LOCH) risk score is available online as a free app: https://ebell-projects.shinyapps.io/LehighRiskScore/.

Keywords: COVID-19; Clinical Decision-Making; Clinical Prediction Rule; Family Medicine; Infectious Diseases; Mobile Applications; Outpatients; Pennsylvania; Retrospective Studies; SARS-CoV-2 Variants.