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    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
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    COVID Home Safely Now (CHOSEN) Risk Score for COVID-19

    Predicts suitability for discharge in COVID-19 patients.

    IMPORTANT

    Launched during COVID-19 crisis. Not externally validated. Use with caution. COVID-19 Resource Center.

    When to Use
    • Consider applying the CHOSEN score to patients with COVID in the emergency department or general medical floor where discharge is being considered.
    • Data inputs should be the most recent available data.
    • CHOSEN predicts whether a patient with COVID in a monitored setting will need oxygen, need the ICU, or die in the next 14 days.
    Yes
    No
    18-45
    +5
    46-59
    +2
    60-73
    +1
    >73
    0
    <94%
    0
    94-96%
    +9
    97-98%
    +14
    >98%
    +21
    <2.8 g/dL (<28 g/L)
    0
    2.8-3.3 g/dL (28-33 g/L)
    +5
    3.4-3.7 g/dL (34-37 g/L)
    +15
    >3.7 g/dL (>37 g/L)
    +29

    Result:

    Please fill out required fields.

    Next Steps
    Evidence
    Creator Insights
    Dr. David M. Levine

    From the Creator

    Why did you develop the CHOSEN Score? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians?

    As the COVID-19 pandemic hit Boston in March 2020 and hospitals were overrun, clinicians were forced to make difficult decisions regarding discharge from a monitored setting. There simply was no evidence base. The typical risk scores, such as CURB-65 or q-SOFA, did not seem appropriate. Our hospital was bursting, yet the decision to discharge a patient was highly variable and based simply on gestalt. Our team wanted to pitch in with data to help inform discharge decisions, both in the emergency department and general medical ward.

    What pearls, pitfalls and/or tips do you have for users of the CHOSEN Score? Do you know of cases when it has been applied, interpreted, or used inappropriately?

    Users should be aware that our dataset was based solely on patients in the early days of the pandemic during the first surge. Therefore, CHOSEN might best be applied during a surge when a hospital is beyond its capacity. Users should also keep in mind that our COVID-19 treatments and pathways have in some ways changed since the beginning of the pandemic. We’ve found that having our small figure for reference can make it easy to remember CHOSEN’s inputs and interpret its outputs. 

    What recommendations do you have for practitioners once they have applied the CHOSEN Score?

    If you don’t have a recent albumin level available, consider using the modified CHOSEN score that can be calculated without laboratory values. This model does not perform quite as well but can be useful particularly in the emergency department where a clinician may not obtain laboratory testing. As always, clinical decision rules do not replace clinical judgment.

    About the Creator

    David M. Levine, MD, MPH, MA, is practicing primary care physician in the Division of General Internal Medicine and Primary Care at Brigham and Women’s Hospital in Massachusetts. He is also an investigator at Brigham and Women's Hospital and Harvard Medical School. Dr. Levine's primary research is focused on digital health, advanced home-based care, and improving the quality of delivered care.

    To view Dr. David M. Levine's publications, visit PubMed

    Are you Dr. David M. Levine? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    About the Creator
    Dr. David M. Levine
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