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    Attention COACH STUDY participants:

    The principal investigators of the study request that you use the official version of the modified score here.

    Veterans Health Administration COVID-19 (VACO) Index for COVID-19 Mortality

    Estimates risk of 30-day mortality after COVID-19 infection using pre-COVID health status.

    IMPORTANT

    Developed in collaboration with the US Department of Health and Human Services (HHS), including the CDC, NIH, VA, and the ASPR.

    This calculator was developed and validated in VA cohorts, and then externally validated in a non-VA patient population, noteworthy because of the VA's predominantly male population. The VACO Index predicts well in all subpopulations in which it was studied. 

    Pearls/Pitfalls
    Why Use
    • The VACO Index estimates 30-day all cause mortality after COVID-19 infection, incorporating demographic data and pre-existing conditions.
    • The VACO Index can be used to screen uninfected patients to identify those at a higher risk of dying should they develop COID-19.
    • While not specifically studied, infected individuals at higher risk of death have more severe disease that is more likely to require hospitalization and intubation.
    • The VACO Index uses demographic and preexisting condition data available in electronic health record and billing data to predict 30-day mortality, and does not require current clinical data. This makes the Index very useful to target high-risk patients within a health system's population.
    • The VACO Index has been validated in two internal cohorts and in one external cohort, a significant advantage over many other COVID-19 risk scores.

    years
    Female
    Male
    Past Medical History for Charlson Comorbidity Index
    None
    0
    Diabetes without complications
    +1
    Diabetes, with complications (e.g., eyes, kidneys, ketoacidosis)
    +2
    No
    0
    Yes
    +1
    No
    0
    Yes
    +2
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    None
    0
    Cancer (except skin cancer)
    +2
    Cancer, metastatic (cancer spreading to another part of the body)
    +6
    No
    0
    Yes
    +1
    None
    0
    Liver disease, mild (e.g., viral hepatitis B or C, alcoholic hepatitis)
    +1
    Liver disease, moderate or severe (e.g., esophageal varices, fatty liver, liver failure)
    +3
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +6
    No
    0
    Yes
    +1

    Result:

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    Next Steps
    Evidence
    Creator Insights
    Dr. Joseph King Jr.

    About the Creator

    Joseph King Jr., MD, MSCE, FAANS, is an Associate Professor of Neurosurgery and Director of Neurosurgical Outcomes Research at the Yale School of Medicine in Connecticut, and the Chief of Neurosurgery at the VA Connecticut Healthcare System. Dr. King's primary research is focused on using large databases to examine health care systems issues, the measurement of patient-oriented outcomes and quality of life in patients with neurologic disease.

    To view Dr. Joseph King Jr.'s publications, visit PubMed

    Dr. Amy Justice

    About the Creator

    Amy Justice, MD, PhD, is the CNH Long Professor of Medicine and of Public Health at Yale University and a Staff Physician at the VA Connecticut Healthcare System. As principal investigator of the Veterans Aging Cohort Study (VACS), she has more than 20 years of experience developing and validating predictive indices using electronic health record data.

    To view Dr. Amy Justice's publications, visit PubMed

    James S. Yoon

    About the Creator

    James S. Yoon is a third year medical student at Yale School of Medicine in Connecticut. His research focuses on value-based healthcare aimed at improving patient experiences through policy reforms, delivery system innovation, and outcomes research that informs safe, evidence-based clinical practices.

    To view James S. Yoon's publications, visit PubMed

    Content Contributors
    • Amy Justice, MD, PhD
    About the Creator
    Dr. Joseph King Jr.
    Dr. Amy Justice
    James S. Yoon
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    Partner Content
    Podcast: The COVID Mortality Score (VACO)

    Listen to the VACO co-creators break down how to use VACO, what it does, and what it doesn’t.

    Content Contributors
    • Amy Justice, MD, PhD