Development and implementation of a COVID-19 near real-time traffic light system in an acute hospital setting. Issue 10 (18th September 2020)

• Record Type: Journal Article
• Authors: Vizcaychipi, Marcela P; Shovlin, Claire L; McCarthy, Alex; Howard, Alice; Brown, Alexander; Hayes, Michelle; Singh, Suveer; Christie, Linsey; Sisson, Alice; Davies, Roger; Lockie, Christopher; Popescu, Monica; Gupta, Amandeep; Armstrong, James; Said, Hisham; Peters, Timothy; T Keays, Richard
• Other Names: author non-byline.; Christopher Abela author non-byline.; Ahmed Al-Hindawi author non-byline.; Joanna Allam author non-byline.; Mauro Arrica author non-byline.; Christelle At author non-byline.; Javier Bargados author non-byline.; Madeleine Beach author non-byline.; Ian Beveridge author non-byline.; Neil Bodagh author non-byline.; Peter Brooks author non-byline.; Alexander Brown author non-byline.; Tom Browning author non-byline.; Charo Bruce author non-byline.; Kiran Chima author non-byline.; James Cofie author non-byline.; Harriet Collier author non-byline.; Jonathan Collier author non-byline.; Declan Collins author non-byline.; Karen Collins author non-byline.; Deirdre Conway author non-byline.; Victoria Cordrey author non-byline.; Caroline Cormack author non-byline.; Alona Courtney author non-byline.; Mark Cox author non-byline.; Cox Sarah author non-byline.; Joshua Cuddihy author non-byline.; Aleck Dalrymple author non-byline.; Paramjeet Deol author non-byline.; Daryl Dob author non-byline.; Juliet Dunn author non-byline.; Jackeline Durbridge author non-byline.; Simon Eccles author non-byline.; Jana Elbadaoui author non-byline.; Muna Elsawahli author non-byline.; Niveen El-Wahab author non-byline.; Philippa Evans author non-byline.; Noel Fee author non-byline.; Emma Forman author non-byline.; Gabriela Frunza author non-byline.; Susan Gallagher author non-byline.; Rea Ganatra author non-byline.; Ajay Gandhi author non-byline.; Davies Gary author non-byline.; Clare Glicksman author non-byline.; Joseph Gonzales author non-byline.; Lisa Greaney author non-byline.; Samuel Greenhalgh author non-byline.; Samuel Gregson author non-byline.; Kevin Haire author non-byline.; Sofia Hanger author non-byline.; Seleena Haque author non-byline.; Alison Hare author non-byline.; Charlie Hensher author non-byline.; Maria Herincs author non-byline.; Alice Howard author non-byline.; Martine Howard author non-byline.; Jones Isabel author non-byline.; Andrzej Jandziol author non-byline.; Mo Jawad author non-byline.; John Jeans author non-byline.; Jo Jennings author non-byline.; Max Julve author non-byline.; Kaur Khera Jacyntha author non-byline.; Ami Kotecha author non-byline.; Manisha Kulkarni author non-byline.; Holly Lamont author non-byline.; Corina Lee author non-byline.; Lee Phillip author non-byline.; William Lever author non-byline.; Li Alex Lignos Leda author non-byline.; Ganga Liyanage author non-byline.; Samantha Luff author non-byline.; Wanda Lui author non-byline.; Georgios Malietzis author non-byline.; Georgina Margiotta author non-byline.; Zuzanna Matasova author non-byline.; Daniel McNaughton author non-byline.; Ayo Meduoye author non-byline.; Hannah Mills author non-byline.; Alex Milne author non-byline.; Marco Morosin author non-byline.; Sarah Morton author non-byline.; Kenneth Murray author non-byline.; Quentin Nelson author non-byline.; Saaman Neriman author non-byline.; Lisa Newell author non-byline.; Bernard Norman author non-byline.; Emma Norton author non-byline.; Ben Nurdin author non-byline.; Catherine Onuorah author non-byline.; Leyla Osman author non-byline.; Catherine O'Sullivan author non-byline.; Chandni Parikh author non-byline.; Saqib Parwez author non-byline.; Shashank Patil author non-byline.; Sherina Peroos author non-byline.; Elspeth Pickering author non-byline.; Kris Pillay author non-byline.; Rob Pilling author non-byline.; Martin Porter-Moore author non-byline.; Olivera Potparic author non-byline.; Kate Richardson author non-byline.; John Roa author non-byline.; Eleanor Roderick author non-byline.; Katherine Russell author non-byline.; Atika Sabharwal author non-byline.; Amee Samani author non-byline.; Aleksei Sedov author non-byline.; Natalie Silvey author non-byline.; Jonathan Simon author non-byline.; James Smellie author non-byline.; Rebecca-Lea Smith author non-byline.; Andrew Snell author non-byline.; Jagdish Sokhi author non-byline.; Ewelina Szubert author non-byline.; Ben Thomas author non-byline.; John Thornton author non-byline.; Lopes Vieira Jose author non-byline.; Leon Villapalos Jorge author non-byline.; Annette Volger author non-byline.; Paul Waddell author non-byline.; Josh Wall author non-byline.; Kate Wannap author non-byline.; Patrick Ward author non-byline.; Ilhan Wardhere author non-byline.; Andrea Weigert author non-byline.; Helen Westall author non-byline.; Maria Wilk author non-byline.; Andrew Williams author non-byline.; Jessica Williams author non-byline.; William Wynn-Jones author non-byline.; Steve Yentis author non-byline.; Noel Young author non-byline.;
• Is Part Of: Emergency medicine journal. Volume 37:Issue 10(2020)
• Page Start: 630
• Page End: 636
• Publication Date: 2020-09-18
• Subjects: emergency care systems -- ventilation -- thrombo-embolic disease -- management -- resuscitation -- clinical care -- infectious diseases -- SARS; Emergency medicine -- Periodicals; 616.02505
• DOI: 10.1136/emermed-2020-210199
• Languages: English
• ISSNs: 1472-0205

Abstract

Abstract : Common causes of death in COVID-19 due to SARS-CoV-2 include thromboembolic disease, cytokine storm and adult respiratory distress syndrome (ARDS). Our aim was to develop a system for early detection of disease pattern in the emergency department (ED) that would enhance opportunities for personalised accelerated care to prevent disease progression. A single Trust's COVID-19 response control command was established, and a reporting team with bioinformaticians was deployed to develop a real-time traffic light system to support clinical and operational teams. An attempt was made to identify predictive elements for thromboembolism, cytokine storm and ARDS based on physiological measurements and blood tests, and to communicate to clinicians managing the patient, initially via single consultants. The input variables were age, sex, and first recorded blood pressure, respiratory rate, temperature, heart rate, indices of oxygenation and C-reactive protein. Early admissions were used to refine the predictors used in the traffic lights. Of 923 consecutive patients who tested COVID-19 positive, 592 (64%) flagged at risk for thromboembolism, 241/923 (26%) for cytokine storm and 361/923 (39%) for ARDS. Thromboembolism and cytokine storm flags were met in the ED for 342 (37.1%) patients. Of the 318 (34.5%) patients receiving thromboembolism flags, 49 (5.3% of all patients) were for suspected thromboembolism, 103 (11.1%) were high-risk and 166 (18.0%) were medium-risk. Of the 89 (9.6%) who received a cytokine storm flag from the ED, 18 (2.0% of all patients) were for suspected cytokine storm, 13 (1.4%) were high-risk and 58 (6.3%) were medium-risk. Males were more likely to receive a specific traffic light flag. In conclusion, ED predictors were used to identify high proportions of COVID-19 admissions at risk of clinical deterioration due to severity of disease, enabling accelerated care targeted to those more likely to benefit. Larger prospective studies are encouraged.