Outpatient Management of Patients With COVID-19: Multicenter Prospective Validation of the HOME-CoV Rule to safely discharge patients

Douillet, D.; Penaloza, A.; Mahieu, R.; Morin, F.; Chauvin, A.; Gennai, S.; Schotte, T.; Montassier, E.; Thiebaut, P.-C.; Ghuysen, A.; Dall’acqua, D.; Benhammouda, K.; Bissokele, P.; Violeau, M.; Joly, L.-M.; Andrianjafy, H.; Soulie, C.; Savary, D.; Riou, J.; Roy, P.-M.

Background The HOME-CoV rule is a checklist of eligibility criteria for home treatment of patients with COVID-19, defined using a Delphi method. Research Question Is the HOME-CoV rule reliable for identifying a subgroup of COVID-19 patients with a low risk of adverse outcomes who can be safely treated at home? Study Design and Methods We aimed to validate the HOME-CoV rule in a prospective multicenter study before and after trial on patients with probable or confirmed COVID-19 who presented at the emergency departments (ED) of 34 hospitals. The main outcome was an adverse evolution, i.e., invasive ventilation or death, occurred within the 7 days following the patients’ admission. The performance of the rule was assessed by the false negative rate. The impact of the rule implementation was assessed by the absolute differences in the rate of patients who required invasive ventilation or who died and in the rate of patients treated at home, between an observational and an interventional period after implementation of the HOME-CoV rule, with propensity score adjustment. Results Among 3000 prospectively enrolled patients, 1239 (41.3%) had a negative HOME-CoV rule. The false negative rate of the HOME-CoV rule and its AUC were 4/1239: 0.32% (95%CI: 0.13 to 0.84%) and 80.9 (95%CI: 76.5 to 85.2), respectively. On the adjusted populations, 25/1274 (1.95%) patients experienced an adverse evolution during the observational period versus 12/1274 (0.95%) during the interventional period: -1.00 (95%CI: -1.86 to -0.15). During the observational period, 858 (67.35%) patients were treated at home versus 871 (68.37%) patients during the interventional period: -1.02 (95%CI -4.46 to 2.26). Interpretation A large proportion of ED patients with probable or confirmed COVID-19 have a negative HOME-CoV rule and can be safely treated at home with a very low risk of complication.