The hypoxia-age-shock index at triage to predict the outcomes of Covid-19 patients

• Published in: The American journal of emergency medicine Vol. 65; pp. 65 - 70
• Main Authors: Hsieh, Chien-Chieh, Liu, Chia-yu, Tsai, Kuang-Chau, Jaw, Fu-Shan, Chen, Jiashan
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2023; Elsevier Limited; Published by Elsevier Inc
• Subjects: Age; Coronaviruses; COVID-19; Creatinine; Critical care medicine; Emergency; Emergency medical care; Hospitalization; Hospitals; Humans; Hypoxia; Illnesses; Infectious diseases; Intensive care; Intensive Care Units; Intubation; Laboratories; Medical personnel; Medical prognosis; Mortality; Oxygen saturation; Pandemics; Patients; Respiratory distress; Retrospective Studies; ROC Curve; Sepsis; Severe acute respiratory syndrome coronavirus 2; Shock; Software; Statistical analysis; Triage; Variables; COVID-19; Respiratory distress; Critical care medicine
• ISSN: 0735-6757; 1532-8171; 1532-8171
• DOI: 10.1016/j.ajem.2022.12.034

The coronavirus disease 2019 (COVID-19) outbreak has caused a severe burden on medical professionals, as the rapid disposition of patients is important. Therefore, we aimed to develop a new clinical assessment tool based on the shock index (SI) and age-shock index (ASI). We proposed the hypoxia-age-shock index (HASI) and determined the usability of triage for COVID-19 infected patients in the first scene. The predictive power for three indexes on mortality, intensive care unit (ICU) admission, and endotracheal intubation rate was evaluated using the receiver operating curve (ROC). We used DeLong's method for comparing the ROCs. The area under the curve (AUC) for ROC on mortality for SI, ASI, and HASI were 0.546, 0.771, and 0.773, respectively. The AUC on ICU admission mortality for SI, ASI, and HASI were 0.581, 0.700, and 0.743, respectively. The AUC for intubation for SI, ASI, and HASI were 0.592, 0.708, and 0.757, respectively. The AUC differences between HASI and SI showed statistically significant (P = 0.001) results on mortality, ICU admission, and intubation. Additionally, statistically significant results were found for the AUC difference between the HASI and ASI on ICU admission and intubation (P = 0.001 and P = 0.004, respectively). HASI can provide a better prediction compared to ASI on ICU admission and endotracheal intubation. HASI was more sensitive in mortality, ICU admission, and intubation prediction than the ASI.