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A rapid, office-based method to select patients with severe COVID-19 who need intensive care was necessary during the peak of the pandemic.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, setting and participants<\/jats:title><jats:p>This is a prospective cohort study of patients with confirmed severe COVID-19 between September 2020 and April 2021.<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcome measures and analysis<\/jats:title><jats:p>Oxygen saturation was obtained at rest (SpO2r), following exertion from a 20 m walk test (SpO2e), and the difference was calculated (SpO2\u0394). Radiographs and laboratory values were obtained and recorded. Logistic regression models were used to determine variables associated with hospitalisation. A lung injury score was used to quantify pulmonary involvement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Out of 103 patients enrolled with severe COVID-19 infection, 19 (18.4%) were admitted to the hospital (no deaths). Patients managed as outpatients had a standard treatment protocol. The SpO2\u0394 and SpO2e were associated with hospitalisation (p&lt;0.005) while SpO2r was no different between non-hospitalised and hospitalised patients (90.7%\u00b12.7% vs 90.8%\u00b12.3%, p=0.87). By contrast, exertional SpO2e was significantly different between non-hospitalised and hospitalised (87.3%\u00b12.6%\u2009vs 84.4%\u00b13.4%, p=0.0005). The mean lung injury score was 11.0\u00b13.5 (18-point scale) and did not discriminate against those who would need hospitalisation. Lower lung fields were significantly more involved than the upper (p&lt;0.0001). All patients had elevated biomarkers of inflammation, C reactive protein (CRP) median 82.5 IQR (43\u2013128.6)\u2009mg\/L and evidence of elevated liver enzymes. A logistic regression model was constructed including SpO2\u0394, CRP and alanine aminotransferase to predict hospitalisation. Only SpO2\u0394 was significant, p=0.012, 95%\u2009CI (1.128 to 2.704) and correctly classified 85.71% of patients who could remain at home or would need to receive treatment in the hospital.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>An office-based, 20 m walk test can help diverge patients with severe COVID-19 who need escalated care. Further, an aggressive standardised treatment protocol can be used to successfully manage patients outside of hospitals despite having severe COVID-19.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2023-073781","type":"journal-article","created":{"date-parts":[[2023,11,29]],"date-time":"2023-11-29T17:57:41Z","timestamp":1701280661000},"page":"e073781","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Use of a rapid triage assessment tool to discriminate the need for hospitalisation in patients with severe COVID-19 infection presenting to an outpatient clinic: a single-centre, prospective cohort study"],"prefix":"10.1136","volume":"13","author":[{"given":"Christopher","family":"Owens","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3398-6382","authenticated-orcid":false,"given":"Chris","family":"Lamb","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julio","family":"Sanchez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariana","family":"Quintero","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alfredo","family":"Lopez-Yunez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,11,29]]},"reference":[{"doi-asserted-by":"crossref","unstructured":"Cavallo JJ , Donoho DA , Forman HP . 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