A study by researchers at the University of Oxford and Imperial College London have developed a checklist of potential predictors that someone may go on to develop a severe form of COVID-19.
The paper, produced as part of the RECAP study, was published in the online open-access journal BMJ Open.
Doctors and other clinicians who assess people over the phone or by video need to know which symptoms to take note of when deciding which people to bring in to assess further or send to hospital.
The study included focus groups and a consensus-building exercise involving 112 clinicians, as well as 50 interviews with patients. It came up with a preliminary list of items which are thought to be associated with a more severe disease course in the first 28 days.
These items are: pulse rate, temperature, fever symptoms (e.g. shivering, chills), respiratory rate, shortness of breath, pulse oximeter reading, post-exercise fall in pulse oximeter reading, tiredness, muscle aches, being on the UK’s ‘shielded list’ of people who have vulnerability to COVID-19, and other risk factors for poor outcome such as age over 65 and non-White ethnicity.
Professor Trisha Greenhalgh, the NIHR Oxford BRC’s Theme Lead for Partnerships for Health, Wealth and Innovation, who led this phase of the study, said: “By tapping into the experience and wisdom of over 100 frontline clinicians, and by carefully analysing the stories told by 50 patients about their experiences, we have developed a list of things we think predict severity in the first two weeks of a COVID-19 illness.
“We now need to test these further to develop a formal score which we’ll be calling RECAP, which stands for REmote COVID Assessment in Primary Care.”
Professor Simon de Lusignan, also from the University of Oxford’s Nuffield Department of Primary Care Health Sciences, said: “The draft RECAP items have been built into GP computer systems. We’re currently collecting data on these items on people suspected of having COVID-19, and we’ll be linking that data with actual outcomes of the illness to validate the score.”
Professor Brendan Delaney from Imperial College London who will be leading the next phase of the RECAP study, said: “We very much hope that a score developed from these items will help GPs and their staff decide more precisely who needs to be rushed to hospital, who needs to be closely monitored, and who can be safely reassured. We’re still recruiting GP practices to be part of the validation phase of the study.”