Screening and diagnosis

Classification and risk stratification

Perioperative care

Quality improvement

Patient education

Nonpharmacologic interventions

Therapeutic procedures

Respiratory support

Follow-up and surveillance

Specific circumstances

Preventative measures

Medical management

Surgical interventions

Inpatient care

Diagnostic procedures

Diagnostic investigations

Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

The Coronavirus Clinical Characterisation Consortium (4C) score estimates the risk of in-hospital mortality for COVID-19 patients based on eight clinical factors. Each factor is associated with specific response options that are assigned numerical values, contributing to the patient's total score.

Here's how the scoring works:

Age, years:
- "< 50" = 0
- "50-59" = 2
- "60-69" = 4
- "70-79" = 6
- ">= 80" = 7

Sex at birth:
- "Female" = 0
- "Male" = 1

Number of comorbidities:
- "0" = 0
- "1" = 1
- ">= 2" = 2

Respiratory rate, breaths/min:
- "< 20" = 0
- "20-29" = 1
- ">= 30" = 2

Peripheral oxygen saturation on room air, %:
- ">= 92" = 0
- "< 92" = 2

Glasgow Coma Scale score:
- "15" = 0
- "< 15" = 2

Blood urea nitrogen, mg/dL:
- "< 19.6" = 0
- "19.6-39.2" = 1
- "> 39.2" = 3

C-reactive protein, mg/L:
- "< 50" = 0
- "50-99" = 1
- ">= 100" = 2

To compute the total score, add the values corresponding to each factor's assessed category. Based on the sum, the following interpretations for in-hospital mortality risk are provided:

- If the total score is 3 or less, the risk is approximately 1.2%.
- A score between 4 and 8 signifies a risk of about 9.9%.
- Scores ranging from 9 to 14 correlate with a 31.4% risk.
- Scores of 15 or higher indicate a risk of 61.5%.

This scoring system helps clinicians quickly assess the severity of a COVID-19 patient's condition and guide treatment decisions.

The 4C score, or the Coronavirus Clinical Characterisation Consortium score, is a clinical calculator specifically designed for patients diagnosed with COVID-19. This scoring system is used to predict the mortality risk in these patients. The 4C score takes into account various factors such as age, sex, number of comorbidities, respiratory rate, peripheral oxygen saturation, Glasgow Coma Scale, urea level, and C-reactive protein level. The clinical utility of this calculator is to assist healthcare professionals in making informed decisions about the level of care required for a patient, including the need for hospitalization, intensive care, or ventilator support. It can also help in prioritizing patients in situations where resources are limited. The 4C score is not applicable to patients without a confirmed diagnosis of COVID-19 or those with incomplete clinical data.

Coronavirus Clinical Characterisation Consortium score for COVID-19 mortality (4C score)

The Coronavirus Anxiety Scale (CAS) is a tool designed to assess anxiety levels pertaining to COVID-19 by examining the user's recent experiences across five questions. These questions explore symptoms such as dizziness, sleep difficulties, feeling paralyzed, loss of appetite, and nausea that are associated with thinking about the coronavirus.

Each response corresponds to an occurrence frequency over the past two weeks and is assigned a numerical score as follows:

- Not at all: 0
- Rare, less than a day or two: 1
- Several days: 2
- More than 7 days: 3
- Nearly every day over the last 2 weeks: 4

To use the CAS, individuals provide answers to each of the five questions. The tool then converts these responses into scores based on the described mappings. Once all scores are gathered, they are summed to produce a total score, which ranges between 0 and 20.

The meaning of the total score is straightforward:
- If the score is less than 9, the interpretation is "Criteria not met," meaning the individual likely does not have significant anxiety related to the COVID-19 crisis.
- A score of 9 or higher leads to an interpretation of "Meets criteria for anxiety associated with COVID-19 crisis," suggesting the person may be experiencing notable anxiety in connection with the pandemic.

Through this structured approach, the CAS helps quantify the user's level of anxiety related to COVID-19 using their self-reported symptoms over the preceding two weeks.

The Coronavirus Anxiety Scale (CAS) is a mental health screening tool specifically designed to assess the severity of anxiety symptoms related to the COVID-19 pandemic. It is applicable to the general population, particularly those who may be experiencing distress or anxiety due to the ongoing pandemic. The clinical utility of the CAS is to identify individuals who may be suffering from dysfunctional anxiety and to monitor changes in anxiety levels over time. It can be used in both clinical and research settings to provide a quantitative measure of COVID-19 related anxiety. There are no specific exclusion criteria for its use, but it should be noted that the CAS is not designed to diagnose anxiety disorders or any other mental health conditions. It is a tool for assessing the severity of specific anxiety symptoms related to the COVID-19 pandemic.

Coronavirus Anxiety Scale (CAS)

The PRIEST score for COVID-19 clinical severity helps evaluate a patient’s risk of adverse outcomes by considering several key health indicators and personal characteristics. For calculation, each aspect is scored based on predefined criteria, reflecting its contribution to clinical severity assessment. Here's how each factor is evaluated:

- Sex: Female gets 0 points, Male gets 1.
- Age:
  - 16-49 years: 0
  - 50-65 years: 2
  - 66-80 years: 3
  - Over 80 years: 4
- Respiratory Rate (breaths per minute):
  - Less than 9: 3
  - Between 9-11: 1
  - Between 12-20: 0
  - Between 21-24: 2
  - More than 24: 3
- Oxygen Saturation:
  - More than 95%: 0
  - Between 94-95%: 1
  - Between 92-93%: 2
  - Less than 92%: 3
- Heart Rate (beats per minute):
  - Less than 41: 3
  - Between 41-50: 1
  - Between 51-90: 0
  - Between 91-110: 1
  - Between 111-130: 2
  - More than 130: 3
- Systolic Blood Pressure (mmHg):
  - Less than 91: 3
  - Between 91-100: 2
  - Between 101-110: 1
  - Between 111-219: 0
  - More than 219: 3
- Temperature:
  - Below 35.1°C (95.18°F): 3
  - Between 35.1-36.0°C (95.18-96.8°F): 1
  - Between 36.1-38.0°C (96.8-100.4°F): 0
  - Between 38.1-39.0°C (100.4-102.2°F): 1
  - Above 39.0°C (102.2°F): 2
- Alertness:
  - Alert: 0
  - Confused/not alert: 3
- Inspired Oxygen:
  - Air: 0
  - Supplemental oxygen: 2
- Performance Status:
  - Unrestricted normal activity: 0
  - Limited strenuous activity/light activity: 1
  - Limited activity/self-care: 2
  - Limited self-care: 3
  - Bed/chair bound, no self-care: 4

The total PRIEST score is derived by summing the scores from these parameters, yielding a result between 0 and 29. This score helps predict the risk of a 30-day adverse outcome, with higher scores suggesting increased risk. The interpretation of the total score is:

- A score of 0-1 corresponds to a 1% risk.
- A score of 2-3 corresponds to a 2% risk.
- A score of 4 suggests a 3% risk.
- Scores increase in risk as follows: 5 (9%), 6 (15%), 7 (18%), 8 (22%), 9 (26%), 10 (29%), 11 (34%), 12 (38%), 13 (46%), 14 (47%), 15 (49%), 16 (55%).
- Scores from 17 to 25 range from 59% to 88% risk.
- A score of 26 or higher indicates over a 99% risk.

The PRIEST (Pandemic Respiratory Infection Emergency System Triage) score is a clinical calculator specifically designed for patients with suspected COVID-19. This scoring system is used to predict the risk of hospital admission and severe outcomes in patients presenting to the emergency department with suspected COVID-19 symptoms. 

The PRIEST score takes into account factors such as age, sex, comorbidities, vital signs, and oxygen saturation levels. The higher the score, the higher the risk of hospital admission and severe outcomes, including death. 

The clinical utility of the PRIEST score is to aid in the triage of patients, helping healthcare providers to identify those who are at higher risk and may require more intensive care or monitoring. 

There are no specific exclusion criteria for the use of the PRIEST score, but it should be noted that it is specifically designed for use in patients with suspected COVID-19 and may not be applicable or accurate in patients with other conditions.

PRIEST score for COVID-19 clinical severity

The Quick COVID-19 Severity Index (qCSI) calculator evaluates the risk of severe illness in COVID-19 patients based on three key health indicators. Users provide data for respiratory rate (in breaths per minute), pulse oximetry (as a percentage), and oxygen flow rate (in liters per minute). Each input is matched against predefined categories, each associated with a score, which collectively form the assessment.

The scoring is as follows:

- Respiratory Rate, breaths/min: 
  - <= 22: 0 points
  - 23-28: 1 point
  - > 28: 2 points

- Pulse Oximetry, %:
  - > 92%: 0 points
  - 89-92%: 2 points
  - <= 88%: 5 points

- Oxygen Flow Rate, L/min:
  - <= 2: 0 points
  - 3-4: 4 points
  - 5-6: 5 points

The total score is the sum of the individual scores from the above categories. Based on the cumulative score, the risk of critical illness within 24 hours is interpreted as follows:

- A score of 0 to 3 indicates a 4% risk of critical illness.
- A score of 4 to 6 indicates a 30% risk.
- A score of 7 to 9 indicates a 44% risk.
- A score of 10 or more indicates a 57% risk.

The Quick COVID-19 Severity Index (qCSI) is a clinical calculator designed specifically for patients with confirmed or suspected COVID-19 infection. The qCSI is used to predict the risk of developing severe respiratory disease, including the need for intubation or high-flow nasal cannula oxygen therapy. It is particularly useful in emergency department settings, where it can help clinicians triage patients and make decisions about hospital admission. The qCSI is based on three parameters: patient age, respiratory rate, and oxygen saturation. It does not apply to patients under the age of 18 or those with chronic respiratory diseases, as these groups were not included in the original study that validated the qCSI.

Quick COVID-19 Severity Index (qCSI)

COVID-19 infection

Personal protective equipment

Personal protective equipment, routine care

Other medications

Other medications (general principles)

COVID-19 care pathways

Inhaled corticosteroids

ICSs

Janus kinase inhibitors

JAK inhibitors

Standard transmission precautions

Management of perioperative bleeding

Molnupiravir

Antipyretics

Antigen testing

Antigen testing, setting

Convalescent plasma

Pre-exposure prophylaxis

Thrombolytic therapy

Specimen collection

Pregnant and breastfeeding patients

Care optimization during pandemic

Psychosocial support

Personal protective equipment, aerosol-generating procedures

Monitoring for adverse effects of medications

Nirmatrelvir/ritonavir

Serology

Management of neuropsychiatric and neurological complications

Intravenous vasopressors

Other medications, famotidine

Thromboprophylaxis, hospitalized patients

Thromboprophylaxis, hospitalized patients, choice of agent

Recruitment maneuvers

Polymerase chain reaction

International classification of diseases coding

ICD coding

General principles

Intravenous fluids

Awake prone positioning

Other medications, fluvoxamine

Noninvasive ventilation

Tocilizumab

Other immunomodulators

Other immunomodulators, IL-1R antagonists

Post-exposure prophylaxis

Equipment and care availability

Other antivirals

Other antivirals, lopinavir/ritonavir

Management of preexisting non-communicable diseases

Antibiotics

Other antivirals, chloroquine/hydroxychloroquine

Intermittent pneumatic compression

Antigen testing (indications)

Supraglottic airways

Mechanical ventilation

Other antivirals, ivermectin

Older patients

Extracorporeal membrane oxygenation

ECMO

Management of anxiety and depressive symptoms

Remdesivir

Thromboprophylaxis, hospitalized patients, indications

Multiple persons per ventilator

Thromboprophylaxis, critically ill patients

Thromboprophylaxis, critically ill patients, indications

Systemic corticosteroids

Thromboprophylaxis, critically ill patients, choice of agent

Thromboprophylaxis, nonhospitalized patients

Thromboprophylaxis, nonhospitalized patients (choice of agent)

Diagnosing septic shock

Endotracheal intubation

Conventional oxygen therapy

Patients with cancer

Rehabilitation

Monoclonal antibodies

Environment for airway management

Antithrombotic therapy

Antithrombotic therapy (AIS)

Triage

Evaluation for thromboembolism

Evaluation for thromboembolism, asymptomatic

Cardiopulmonary resuscitation

Updated 2024 IDSA guidelines on serologic testing for COVID-19 infection


Updated 2024 ISTH guidelines for antithrombotic therapy in COVID-19 infection


Updated 2024 IDSA guidelines for pemivibart pre-exposure prophylaxis for COVID-19


COVID-19 infection

Background

Overview

Guidelines

Key sources