Accuracy of the Canadian COVID-19 Mortality Score (CCMS) to predict in-hospital mortality among vaccinated and unvaccinated patients infected with Omicron: a cohort study
Objective The objective is to externally validate and assess the opportunity to update the Canadian COVID-19 Mortality Score (CCMS) to predict in-hospital mortality among consecutive non-palliative COVID-19 patients infected with Omicron subvariants at a time when vaccinations were widespread.Design...
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BMJ Publishing Group
2024-11-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/14/11/e083280.full |
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| author | John Taylor Megan Landes Corinne M Hohl Katie Lin Andrew McRae Steven C Brooks Raoul Daoust Éric Mercier Patrick M Archambault Ivy Cheng Daniel Ting Tomislav Jelic Robert Ohle Philip Davis Justin Yan Laurie J Morrison Ian Martin Jeffrey Perry Rhonda Rosychuk Brian Rowe Michelle Welsford Patrick Fok Hana Wiemer Samuel Campbell Kory Arsenault Tara Dahn Kavish Chandra Joel Turner Greg Clark Sébastien Robert Rohit Mohindra Stephanie VandenBerg Jaspreet Khangura Maja Stachura Frank Scheuermeyer Sean Wormsbecker Lee Graham Baljeet Brar Lars Grant David S Yeom Jake Haward Elizabeth Purssell |
| author_facet | John Taylor Megan Landes Corinne M Hohl Katie Lin Andrew McRae Steven C Brooks Raoul Daoust Éric Mercier Patrick M Archambault Ivy Cheng Daniel Ting Tomislav Jelic Robert Ohle Philip Davis Justin Yan Laurie J Morrison Ian Martin Jeffrey Perry Rhonda Rosychuk Brian Rowe Michelle Welsford Patrick Fok Hana Wiemer Samuel Campbell Kory Arsenault Tara Dahn Kavish Chandra Joel Turner Greg Clark Sébastien Robert Rohit Mohindra Stephanie VandenBerg Jaspreet Khangura Maja Stachura Frank Scheuermeyer Sean Wormsbecker Lee Graham Baljeet Brar Lars Grant David S Yeom Jake Haward Elizabeth Purssell |
| author_sort | John Taylor |
| collection | DOAJ |
| description | Objective The objective is to externally validate and assess the opportunity to update the Canadian COVID-19 Mortality Score (CCMS) to predict in-hospital mortality among consecutive non-palliative COVID-19 patients infected with Omicron subvariants at a time when vaccinations were widespread.Design This observational study validated the CCMS in an external cohort at a time when Omicron variants were dominant. We assessed the potential to update the rule and improve its performance by recalibrating and adding vaccination status in a subset of patients from provinces with access to vaccination data and created the adjusted CCMS (CCMSadj). We followed discharged patients for 30 days after their index emergency department visit or for their entire hospital stay if admitted.Setting External validation cohort for CCMS: 36 hospitals participating in the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN). Update cohort for CCMSadj: 14 hospitals in CCEDRRN in provinces with vaccination data.Participants Consecutive non-palliative COVID-19 patients presenting to emergency departments.Main outcome measures In-hospital mortality.Results Of 39 682 eligible patients, 1654 (4.2%) patients died. The CCMS included age, sex, residence type, arrival mode, chest pain, severe liver disease, respiratory rate and level of respiratory support and predicted in-hospital mortality with an area under the curve (AUC) of 0.88 (95% CI 0.87 to 0.88) in external validation. Updating the rule by recalibrating and adding vaccination status to create the CCMSadj changed the weights for age, respiratory status and homelessness, but only marginally improved its performance, while vaccination status did not. The CCMSadj had an AUC of 0.91 (95% CI 0.89 to 0.92) in validation. CCMSadj scores of <10 categorised patients as low risk with an in-hospital mortality of <1.6%. A score>15 had observed mortality of >56.8%.Conclusions The CCMS remained highly accurate in predicting mortality from Omicron and improved marginally through recalibration. Adding vaccination status did not improve the performance. The CCMS can be used to inform patient prognosis, goals of care conversations and guide clinical decision-making for emergency department patients with COVID-19. |
| format | Article |
| id | doaj-art-4f4f9355f7ad481a9dc865a9180d157c |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-4f4f9355f7ad481a9dc865a9180d157c2024-11-26T05:15:13ZengBMJ Publishing GroupBMJ Open2044-60552024-11-01141110.1136/bmjopen-2023-083280Accuracy of the Canadian COVID-19 Mortality Score (CCMS) to predict in-hospital mortality among vaccinated and unvaccinated patients infected with Omicron: a cohort studyJohn TaylorMegan LandesCorinne M Hohl0Katie LinAndrew McRaeSteven C Brooks1Raoul DaoustÉric MercierPatrick M Archambault2Ivy ChengDaniel TingTomislav JelicRobert OhlePhilip DavisJustin Yan3Laurie J Morrison4Ian MartinJeffrey Perry5Rhonda Rosychuk6Brian RoweMichelle WelsfordPatrick FokHana WiemerSamuel CampbellKory ArsenaultTara DahnKavish ChandraJoel TurnerGreg ClarkSébastien RobertRohit MohindraStephanie VandenBergJaspreet KhanguraMaja StachuraFrank ScheuermeyerSean WormsbeckerLee GrahamBaljeet BrarLars GrantDavid S Yeom7Jake HawardElizabeth Purssell2 Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada7 Departments of Emergency Medicine and Public Health Sciences, Queen`s University, Kingston, Ontario, Canada5 Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Québec, Canada3 Division of Emergency Medicine, Department of Medicine, Western University, London, Ontario, Canada8 Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada11 Ottawa Hospital Research Institute, Ottawa, Ontario, Canada12 Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada1 Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, CanadaObjective The objective is to externally validate and assess the opportunity to update the Canadian COVID-19 Mortality Score (CCMS) to predict in-hospital mortality among consecutive non-palliative COVID-19 patients infected with Omicron subvariants at a time when vaccinations were widespread.Design This observational study validated the CCMS in an external cohort at a time when Omicron variants were dominant. We assessed the potential to update the rule and improve its performance by recalibrating and adding vaccination status in a subset of patients from provinces with access to vaccination data and created the adjusted CCMS (CCMSadj). We followed discharged patients for 30 days after their index emergency department visit or for their entire hospital stay if admitted.Setting External validation cohort for CCMS: 36 hospitals participating in the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN). Update cohort for CCMSadj: 14 hospitals in CCEDRRN in provinces with vaccination data.Participants Consecutive non-palliative COVID-19 patients presenting to emergency departments.Main outcome measures In-hospital mortality.Results Of 39 682 eligible patients, 1654 (4.2%) patients died. The CCMS included age, sex, residence type, arrival mode, chest pain, severe liver disease, respiratory rate and level of respiratory support and predicted in-hospital mortality with an area under the curve (AUC) of 0.88 (95% CI 0.87 to 0.88) in external validation. Updating the rule by recalibrating and adding vaccination status to create the CCMSadj changed the weights for age, respiratory status and homelessness, but only marginally improved its performance, while vaccination status did not. The CCMSadj had an AUC of 0.91 (95% CI 0.89 to 0.92) in validation. CCMSadj scores of <10 categorised patients as low risk with an in-hospital mortality of <1.6%. A score>15 had observed mortality of >56.8%.Conclusions The CCMS remained highly accurate in predicting mortality from Omicron and improved marginally through recalibration. Adding vaccination status did not improve the performance. The CCMS can be used to inform patient prognosis, goals of care conversations and guide clinical decision-making for emergency department patients with COVID-19.https://bmjopen.bmj.com/content/14/11/e083280.full |
| spellingShingle | John Taylor Megan Landes Corinne M Hohl Katie Lin Andrew McRae Steven C Brooks Raoul Daoust Éric Mercier Patrick M Archambault Ivy Cheng Daniel Ting Tomislav Jelic Robert Ohle Philip Davis Justin Yan Laurie J Morrison Ian Martin Jeffrey Perry Rhonda Rosychuk Brian Rowe Michelle Welsford Patrick Fok Hana Wiemer Samuel Campbell Kory Arsenault Tara Dahn Kavish Chandra Joel Turner Greg Clark Sébastien Robert Rohit Mohindra Stephanie VandenBerg Jaspreet Khangura Maja Stachura Frank Scheuermeyer Sean Wormsbecker Lee Graham Baljeet Brar Lars Grant David S Yeom Jake Haward Elizabeth Purssell Accuracy of the Canadian COVID-19 Mortality Score (CCMS) to predict in-hospital mortality among vaccinated and unvaccinated patients infected with Omicron: a cohort study BMJ Open |
| title | Accuracy of the Canadian COVID-19 Mortality Score (CCMS) to predict in-hospital mortality among vaccinated and unvaccinated patients infected with Omicron: a cohort study |
| title_full | Accuracy of the Canadian COVID-19 Mortality Score (CCMS) to predict in-hospital mortality among vaccinated and unvaccinated patients infected with Omicron: a cohort study |
| title_fullStr | Accuracy of the Canadian COVID-19 Mortality Score (CCMS) to predict in-hospital mortality among vaccinated and unvaccinated patients infected with Omicron: a cohort study |
| title_full_unstemmed | Accuracy of the Canadian COVID-19 Mortality Score (CCMS) to predict in-hospital mortality among vaccinated and unvaccinated patients infected with Omicron: a cohort study |
| title_short | Accuracy of the Canadian COVID-19 Mortality Score (CCMS) to predict in-hospital mortality among vaccinated and unvaccinated patients infected with Omicron: a cohort study |
| title_sort | accuracy of the canadian covid 19 mortality score ccms to predict in hospital mortality among vaccinated and unvaccinated patients infected with omicron a cohort study |
| url | https://bmjopen.bmj.com/content/14/11/e083280.full |
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