Monitoring

Regularly monitor the following in hospitalized patients to facilitate early recognition of deterioration and monitor for complications:[85]

  • Vital signs (temperature, respiratory rate, heart rate, blood pressure, oxygen saturation)

  • Hematologic and biochemistry parameters

  • Coagulation parameters (D-dimer, fibrinogen, platelet count, prothrombin time)

  • ECG

  • Chest imaging

  • Signs and symptoms of venous or arterial thromboembolism.

Medical early warning scores

  • Utilize medical early warning scores that facilitate early recognition and escalation of treatment of deteriorating patients (e.g., National Early Warning Score 2 [NEWS2], Pediatric Early Warning Signs [PEWS]) where possible.[85]

  • There is a lack of data on the value of using these scores in patients with COVID-19 in the primary care setting.

    • A systematic review and meta-analysis found that the NEWS2 score had moderate sensitivity and specificity in predicting the deterioration of patients with COVID-19. The score showed good discrimination in predicting the combined outcome of the need for intensive respiratory support, admission to the intensive care unit, or in-hospital mortality.[473]

  • The sequential organ failure assessment (SOFA) score does not possess adequate discriminant accuracy for mortality prediction in patients prior to intubation for COVID-19 pneumonia.[1162] However, it may be more accurate than other scores.[474]

Pregnant women

  • Fetal well-being should be monitored. The frequency of fetal heart rate observations should be individualized based on gestational age, maternal clinical status (e.g., hypoxia), and fetal conditions.[85]

Post-discharge follow-up

  • Patients who have had suspected or confirmed COVID-19 (of any disease severity) who have persistent, new, or changing symptoms should have access to follow-up care.[85]

  • Guidelines for the respiratory follow-up of patients with COVID-19 pneumonia have been published. Follow-up algorithms depend on the severity of pneumonia, and may include clinical consultation and review (face-to-face or telephone) by a doctor or nurse, chest imaging, pulmonary function tests, echocardiogram, sputum sampling, walk test, and assessment of oxygen saturation.[1163]

  • More than half of patients discharged from hospital had lung function and chest imaging abnormalities 12 weeks after symptom onset.[1164] Pulmonary function tests may reveal altered diffusion capacity, a restrictive pattern, or an obstructive pattern.[1165] Impaired diffusion capacity was more severe and recovered slower in females compared with males, and the first 3 months was the critical recovery period for diffusion capacity.[1166]

Prognostic scores

  • Various prognostic and clinical risk scores are being researched or developed.

  • A living systematic review found that found that QCOVID can be used for risk stratification in the general population, while the PRIEST model, ISARIC4C Deterioration model, Carr’s model, and Xie’s model are suitable for prognostication in a hospital setting.[1167] The Knight 4C Mortality Score and Wang model also show promise in the hospital setting.[1168] However, there is considerable heterogeneity in the performance of prognostic scores for predicting short-term mortality in hospitalized patients across regions and countries. Only half of the models in one systematic review showed good discrimination when externally validated.[1169]​

  • Further external validation across various populations is needed before their use can be recommended. The World Health Organization recommends using clinical judgment, including consideration of the patient’s values and preferences and local and national policy if available, to guide management decisions including admission to hospital and to the intensive care unit, rather than currently available prediction models for prognosis.[85]

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