Original article
The challenge of deciding between home-discharge versus hospitalization in COVID-19 patients: The role of initial imaging and clinicolaboratory data

https://doi.org/10.1016/j.cegh.2020.11.006Get rights and content
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Abstract

Background/Objective

It is important to predict the COVID-19 patient's prognosis, particularly in countries with lack or deficiency of medical resource for patient's triage management. Currently, WHO guideline suggests using chest imaging in addition to clinicolaboratory evaluation to decide on triage between home-discharge versus hospitalization. We designed our study to validate this recommendation to guide clinicians. This study providing some suggestions to guide clinicians for better decision making in 2020.

Methods

In this retrospective study, patients with RT-PCR confirmed COVID-19 (N = 213) were divided in different clinical and management scenarios: home-discharge, ward hospitalization and ICU admission. We reviewed the patient's initial chest CT if available. We evaluated quantitative and qualitative characteristics of CT as well as relevant available clinicolaboratory data. Chi-square, One-Way ANOVA and Paired t-test were used for analysis.

Results

The finding showed that most patients with mixed patterns, pleural effusion, 5 lobes involved, total score ≥10, SpO2% ≤ 90, ESR (mm/h) ≥ 60 and WBC (103/μL) ≥ 8000 were hospitalized. Most patients with Ground-glass opacities only, ≤3 lobes involvement, peripheral distribution, SpO2% ≥ 95, ESR (mm/h) < 30 and WBC(103/μL) < 6000 were home-discharged.

Conclusions

This study suggests the use of initial chest CT (qualitative and quantitative evaluation) in addition to initial clinicolaboratory data could be a useful supplementary method for clinical management and it is an excellent decision making tool (home-discharge versus ICU/Ward admission) for clinicians.

Keywords

Human coronavirus
COVID-19
CT scan
Prognosis
Medical imaging
SARS-CoV

Abbreviations

COVID-19
Coronavirus disease 19
CT
Computed tomography
ICU
Intensive care unit
RT-PCR
real-time polymerase chain reaction
SpO2
Peripheral oxygen saturation
ESR
Erythrocyte sedimentation rate
WBC
White blood cells
CRP
C-Reactive protein
GGO
Ground-glass opacities
RUL
Right upper lobe
RML
Right middle lobe
RLL
Right lower lobe
LUL
Left upper lobe
LLL
Left Lower Lobe

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