RT Journal Article SR Electronic T1 The CCEDRRN COVID-19 Mortality Score to predict death among nonpalliative patients with COVID-19 presenting to emergency departments: a derivation and validation study JF CMAJ Open JO CMAJ FD Canadian Medical Association SP E90 OP E99 DO 10.9778/cmajo.20210243 VO 10 IS 1 A1 Corinne M. Hohl A1 Rhonda J. Rosychuk A1 Patrick M. Archambault A1 Fiona O’Sullivan A1 Murdoch Leeies A1 Éric Mercier A1 Gregory Clark A1 Grant D. Innes A1 Steven C. Brooks A1 Jake Hayward A1 Vi Ho A1 Tomislav Jelic A1 Michelle Welsford A1 Marco L.A. Sivilotti A1 Laurie J. Morrison A1 Jeffrey J. Perry A1 , YR 2022 UL http://www.cmajopen.ca/content/10/1/E90.abstract AB Background: Predicting mortality from COVID-19 using information available when patients present to the emergency department can inform goals-of-care decisions and assist with ethical allocation of critical care resources. The study objective was to develop and validate a clinical score to predict emergency department and in-hospital mortality among consecutive nonpalliative patients with COVID-19; in this study, we define palliative patients as those who do not want resuscitative measures, such as intubation, intensive care unit care or cardiopulmonary resuscitation.Methods: This derivation and validation study used observational cohort data recruited from 46 hospitals in 8 Canadian provinces participating in the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN). We included adult (age ≥ 18 yr) nonpalliative patients with confirmed COVID-19 who presented to the emergency department of a participating site between Mar. 1, 2020, and Jan. 31, 2021. We randomly assigned hospitals to derivation or validation, and prespecified clinical variables as candidate predictors. We used logistic regression to develop the score in a derivation cohort and examined its performance in predicting emergency department and in-hospital mortality in a validation cohort.Results: Of 8761 eligible patients, 618 (7.0%) died. The CCEDRRN COVID-19 Mortality Score included age, sex, type of residence, arrival mode, chest pain, severe liver disease, respiratory rate and level of respiratory support. The area under the curve was 0.92 (95% confidence interval [CI] 0.90–0.93) in derivation and 0.92 (95% CI 0.90–0.93) in validation. The score had excellent calibration. These results suggest that scores of 6 or less would categorize patients as being at low risk for in-hospital death, with a negative predictive value of 99.9%. Patients in the low-risk group had an in-hospital mortality rate of 0.1%. Patients with a score of 15 or higher had an observed mortality rate of 81.0%.Interpretation: The CCEDRRN COVID-19 Mortality Score is a simple score that can be used for level-of-care discussions with patients and in situations of critical care resource constraints to accurately predict death using variables available on emergency department arrival. The score was derived and validated mostly in unvaccinated patients, and before variants of concern were circulating widely and newer treatment regimens implemented in Canada. Study registration: ClinicalTrials.gov, no. NCT04702945