Emergency Departments see critically ill patients with COVID-19. Families and care providers often have to make immediate management decisions about whether or not to intubate hypoxic patients. That decision has substantial downstream implications for patients and the health system. For patients a course of mechanical ventilation is commonly prolonged (average 13 days), and fraught with long-term sequelae, and often does not prevent death. Intubation takes patients’ ability to eat, speak and communicate with their loved ones away – some may not wish to be intubated in this situation if their mortality remains high. From a systems perspective, initiating mechanical ventilation impacts critical care capacity profoundly, as the average length of mechanical ventilation is 13 days. Understanding patients’ mortality risk can help avert intubating patients who are highly likely to die despite maximum medical intervention.
We have developed a simple risk prediction tool that can accurately estimate a patient’s risk of dying despite maximum medical intervention.1 To do this, we used data from nearly 9,000 COVID-19 patients who presented to Emergency Departments. Unlike other scores, we excluded patients who were already deemed palliative before getting COVID-19, to ensure our mortality risk score truly reflects patients we would otherwise intubate.
The variables age, sex, where the patient lives, arrival mode, chest pain, liver disease and respiratory parameters including oxygen requirements were highly predictive of mortality and can be ascertained at triage or at the bedside. This risk score needs to be re-validated for use in vaccinated patients but should work well for unvaccinated patients which constitute the majority of patients with severe COVID-19 in Canada today.
This post was copyedited by Parnian Pardis.
- 1.Hohl C, Rosychuk R, Archambault P, et al. The CCEDRRN COVID-19 Mortality Score to predict death among nonpalliative patients with COVID-19 presenting to emergency departments: a derivation and validation study. CMAJ Open. 2022;10(1):E90-E99. doi:10.9778/cmajo.20210243