IntroductionRisk factors of adverse outcomes in COVID-19 are defined but stratification of mortality using non-laboratory measured scores, particularly at the time of prehospital SARS-CoV-2 testing, is lacking.MethodsMultivariate regression with bootstrapping was used to identify independent mortality predictors in patients admitted to an acute hospital with a confirmed diagnosis of COVID-19. Predictions were externally validated in a large random sample of the ISARIC cohort (N=14 231) and a smaller cohort from Aintree (N=290).Results983 patients (median age 70, IQR 53–83; in-hospital mortality 29.9%) were recruited over an 11-week study period. Through sequential modelling, a five-predictor score termed SOARS (SpO2, Obesity, Age, Respiratory rate, Stroke history) was developed to correlate COVID-19 severity across low, moderate and high strata of mortality risk. The score discriminated well for in-hospital death, with area under the receiver operating characteristic values of 0.82, 0.80 and 0.74 in the derivation, Aintree and ISARIC validation cohorts, respectively. Its predictive accuracy (calibration) in both external cohorts was consistently higher in patients with milder disease (SOARS 0–1), the same individuals who could be identified for safe outpatient monitoring. Prediction of a non-fatal outcome in this group was accompanied by high score sensitivity (99.2%) and negative predictive value (95.9%).ConclusionThe SOARS score uses constitutive and readily assessed individual characteristics to predict the risk of COVID-19 death. Deployment of the score could potentially inform clinical triage in preadmission settings where expedient and reliable decision-making is key. The resurgence of SARS-CoV-2 transmission provides an opportunity to further validate and update its performance.
In the largest prospective study of post-TBI anosmia, the incidence increased with TBI severity and other medical illness. The presence of anosmia should also raise the clinical suspicion of depression.
Objectives:To assess the impact of social deprivation on Traumatic Brain Injury (TBI) global outcome, measured at 12 months post injury. Design:The study was a prospective observational study conducted using consecutive admissions with TBI. Subjects: 1322 consecutive adult patients with TBI were recruited into the study between 2010 and 2015. A total number of 1191 completed the 12 month follow up period. Methods: All patients were assessed by the TBI rehabilitation team at both six weeks and 12 months following TBI. Details of the injury and demographic data was collated at six weeks. This included age, gender, medical comorbidities, ZIP Code and GCS. Social deprivation was measured by the Indices of Multiple Deprivation (IMD) Score. The outcome measure used was the Extended Glasgow Outcome Score (GOSE) at 12 months. Univariate analyses were followed by a Multi-Ordinal Regression to evaluate predictor variables. Results: With regard to the representation of IMD deciles, the study population approximated to the general Sheffield population (p=0.139). Within the univariate analyses, statistically significant relationships were noted between IMD and GOSE (p=<0.001). There was no relationship noted between IMD and GCS at the time of injury (p=0.409), or medical co-morbidity (p=0.682). The Ordinal Regression revealed a significant relationship between worse GOSE and IMD (p=0.002), age (p=0.001), GCS (p<0.001), alcohol intoxication (p<0.001) and Medical Comorbidity (p=0.041). Conclusions: Increasing social deprivation is associated with poorer global TBI outcomes at 12 months. Furthermore, age, TBI severity and Pre-existing Medical comorbidity are all associated with a poorer TBI outcome at 12 months. This highlights the importance of social deprivation in determining TBI outcome.
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