New Scoring Model Helps Clinics Determine Risk of Hospitalization, Death for Patients With COVID-19


A new scoring model is helping to determine the risk of hospitalization and death for patients being treated for COVID-19 in outpatient clinics such as urgent care centers.

A new scoring model can help predict hospitalization, critical illness, or death for coronavirus disease 2019 (COVID-19) presenting patients at urgent care centers, according to a study published in The Journal of Infectious Disease.1

The COVID-19 pandemic has caused over 1.2 million deaths and there have been more than 46.8 million confirmed cases worldwide, according to the World Health Organization.2 The virus has had a dramatic effect on the health care system, including urgent care facilities.1

In order to help limit the spread of COVID-19, Massachusetts General Hospital closed most outpatient facilities and set up new Respiratory Illness Clinics, according to the study. The clinics were staffed by reassigned nurses and clinicians, and many had little urgent care experience. Investigators developed a COVID-19 Acuity Score (Cova) in order to better determine a patient’s risk for hospital admission, ICU admission, or death within 7 days.1

The score uses demographic, medical history, clinical, and radiographic variables to determine risk. Data was collected between March 7, 2020 and May 14, 2020. All patients were assigned to a developmental cohort or a prospective cohort, and were admitted through the emergency department or the respiratory clinics.1

Investigators found that in the developmental cohort, which was made up of 9381 people, 35.6% of patients had adverse events within 7 days of presentation, 27.3% were hospitalized, 7.2% received treatment in an intensive care unit (ICU) or mechanical ventilation, and 1.1% had died. In the prospective cohort, which was made up of 2205 people, 32.9% of patients had adverse events, 26.1% were hospitalized, 6.3% received ICU treatment or mechanical ventilation, and 0.5% died, according to the study.1

"While several other groups have developed risk scores for complications of COVID-19, ours is unique in being based on such a large patient sample, being prospectively validated, and in being specifically designed for use in the outpatient setting, rather than for patients who are already hospitalized," Shivani Mukerji, MD, PhD said in a prepared statement. "Cova is designed so that automated scoring could be incorporated into electronic medical record systems. We hope that it will be useful in case of future COVID-19 surges, when rapid clinical assessments may be critical."3


  1. Haoqi S, Aayushee J, Leone M, et al. Cova: An Acuity Score for Outpatient Screening that Predicts COVID-19 Prognosis. The Journal of Infectious Diseases. Published October 24, 2020. Accessed October 30, 2020.
  2. WHO Coronavirus Disease (COVID-19) Dashboard. The World Health Organization. Updated November 3, 2020. Accessed November 3, 2020.
  3. Risk score predicts prognosis of outpatients with COVID-19 [News Release] October 26, 2020; Boston, MA: Massachusetts General Hospital . Accessed October 30, 2020.
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