Why did you develop the CIRC Score? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians?
We recognized early on in the pandemic that we had a limited amount of time to learn from our initial care of COVID-19 patients in the spring of 2020 in order to be able to help with the inevitable surge of cases in the fall and winter of 2020-2021. We leveraged the power of our existing Precision Medicine Analytics Platform (PMAP) to create the COVID-19 Precision Medicine Center of Excellence to help providers on the frontline navigate clinical decisions with patients and their families. We also wanted to provide information that could help in operational decisions as hospitals could be faced with shortages in critical resources such as ICU beds.
What pearls, pitfalls and/or tips do you have for users of the CIRC Score? Do you know of cases when it has been applied, interpreted, or used inappropriately?
CIRC uses factors on admission to the hospital to predict the likelihood that a patient with COVID-19 will develop severe disease (defined as requiring hi-flow nasal cannula oxygen, non-invasive ventilation, mechanical ventilation or vasopressor support) or death in the next 7 days. It should not be applied to patients who have already developed severe COVID-19 or to patients who do not have a confirmed diagnosis of SARS-CoV-2, the virus that causes COVID-19. CIRC was developed using labs and vital signs from within the first 24hrs of admission. It should not be used at later time points during a patient’s hospital course, and should not be used to substitute for independent clinical judgment.
What recommendations do you have for doctors once they have applied the CIRC Score? Are there any adjustments or updates you would make to the score based on new data or practice changes?
Doctors should discuss with patients and their family members about the possibility that they might develop severe disease or even die from COVID-19. This is best done early on in a patient’s hospital stay to understand a patient’s goals and preferences. CIRC was developed early on in the pandemic, using data from admissions in March and April to a 5-hospital health system. We have checked the performance on admissions at later time points and it performs similarly despite changes in care and the epidemiology of COVID-19 over time (unpublished data).
How do you use the CIRC Score in your own clinical practice? Can you give an example of a scenario in which you use it?
I use CIRC when admitting a patient to the hospital who has COVID-19 and has not yet developed severe disease. It provides a general sense of that patient’s risk of becoming seriously ill or perhaps even dying.
Any other research in the pipeline that you’re particularly excited about?
We have several ongoing projects through the Johns Hopkins Precision Medicine Center of Excellence for COVID-19 that have contributed to our understanding of COVID-19. CIRC was our first clinical prediction tool for COVID-19. We have also developed an updated tool that uses longitudinal data to provide more accurate predictions that can be used at any time point during the first 2 weeks of a patient’s hospital stay. This new tool is currently incorporated in the electronic health record at Johns Hopkins for use by frontline COVID-19 providers. We have also conducted a number of retrospective studies to understand the real-world effectiveness of COVID-19 therapeutics and to understand the pathobiology of COVID-19.
