Outpatient management or hospitalization of patients with proven or suspected SARS-CoV-2 infection: the HOME-CoV rule

Delphine Douillet (1, 2, 3) , Rafael Mahieu (1, 4) , Violette Boiveau (1) , Yves-Marie Vandamme (1) , Aurore Armand (1) , François Morin (1) , Dominique Savary (1, 5) , Vincent Dubée (1, 4) , Cédric Annweiler (1, 6) , Pierre-Marie Roy (1, 2, 3)

1 CHU Angers - Centre Hospitalier Universitaire d'Angers
2 MITOVASC - MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale
3 UA - Université d'Angers
4 CRCINA - Centre de Recherche en Cancérologie et Immunologie Nantes-Angers
5 Irset - Institut de recherche en santé, environnement et travail
6 UWO - University of Western Ontario

In the context of the COVID-19 pandemic and overloaded hospitals, a central issue is the need to define reliable and consensual criteria for hospitalization or outpatient management in mild cases of COVID-19. Our aim was to define an easy-to-use clinical rule aiming to help emergency physicians in hospitalization or outpatient management decision-making for patients with suspected or confirmed SARS-CoV-2 infection (the HOME-CoV rule). The Delphi method was used to reach a consensus of a large panel of 51 experts: emergency physicians, geriatricians, infectious disease specialists, and ethical consultants. A preliminary list of eligible criteria was compiled based on a literature review. Four rounds of anonymized expert consultations were performed. The experts were asked to score each item as relevant, possibly relevant and non-relevant, as major or minor, and to choose the cut-off. They were also able make suggestions and remarks. Eight criteria constituting the HOME-CoV were selected: six correspond to the severity of clinical signs, one to the clinical course (clinically significant worsening within the last 24 h), and the last corresponds to the association of a severe comorbidity and an inadequate living context. Hospitalization is deemed necessary if a patient meets one or more of the criteria. In the end, 94.4% of the experts agreed with the defined rule. Thanks to the Delphi method, an absolute consensus was obtained of a large panel of experts on the HOME-CoV rule, a decision-making support mechanism for clinicians to target patients with suspected or confirmed COVID-19 requiring hospitalization. Trial registration: NCT04338841.

Mots clés: COVID-19; Hospitalization; Outpatient; Delphi method; Expert consensus; Rule-based decision-making; covid-19; hospitalization; outpatient; expert consensus; rule-based decision-making

Domaines: Sciences du Vivant [q-bio]; Médecine humaine et pathologie

Delphine Douillet, Rafael Mahieu, Violette Boiveau, Yves-Marie Vandamme, Aurore Armand, et al.. Outpatient management or hospitalization of patients with proven or suspected SARS-CoV-2 infection: the HOME-CoV rule. Internal and Emergency Medicine, 2020, 15 (8), pp.1525-1531. ⟨10.1007/s11739-020-02483-0⟩. ⟨hal-02964159⟩