New COVID-19 Clinical Risk Management Tools

The development of novel COVID-19 clinical risk stratification tools that incorporate multi-ethnic age structures, multimorbidity and other deprivation metrics to eradicate inequality based on ethinicity.

The need for new clinical risk management tools is very important to help hospital healthcare workers prevent the deaths and intensive care admissions of COVID-19 patients with pneumonia.

The call for healthcare policy change comes after a new study led by the University of Birmingham revealed that ethnic minority COVID-19 patients are more likely to be admitted to hospital suffering pneumonia and requiring intensive care.

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‘COVID-19 clinical risk management tools to narrow the gap on health inequalities are needed.’

These patients are from areas with the highest levels of household overcrowding, air pollution, poor housing quality and adult skills deprivation.

The first of its kind study of 3,671 patients with COVID-19 admitted to four Midland hospitals provides new important and detailed insights into the contrasts between ethnic minorities and Caucasians. This study findings are published in the journal BMJ Open Respiratory Research.

It is found that 81.5% of ethnic minority COVID-19 patients were more likely to be admitted to hospital from regions of highest air pollution deprivation compared with 46.9% of Caucasians.

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81.7% of hospitalised ethnic minority COVID-19 patients were more likely to be admitted from regions of highest household overcrowding deprivation compared with 50.2% of Caucasian.

The study also found that existing tools used by doctors to predict or measure risk and manage the care of COVID-19 patients with pneumonia are insufficient, and can result in underscoring of ethnic minority patients.

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This is particularly due to the fact that often they do not take into consideration that ethnic minority patients are at greater risk of serious illness with COVID-19 at a younger age than Caucasians.

The study found those patients hospitalized of ethnic minorities included Indian, Pakistani, African, Chinese, Bangladeshi and any other non-Caucasian ethnic group were under the age of 65, while Caucasians were older than 65.

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Existing scoring also does not take into account important risk factors that ethnic minority patients are much more exposed or vulnerable to, including suffering multiple pre-existing underlying health conditions, obesity, and deprivation, such as living in overcrowded households or areas of high pollution.

Researchers say that underscoring can also lead to inappropriate levels of care as clinicians are left falsely reassured regarding the severity of illness and risk of a patient’s deterioration.

The results showed ethnic minority patients with pneumonia and low CURB65 scores – a tool used by clinicians to predict severity of pneumonia had higher mortality than Caucasians (22.6% vs 9.4% respectively). Africans were at highest risk (38.5%), followed by Caribbean (26.7%), Indian (23.1%), and Pakistani (21.2%) patients.

This study demonstrates an urgent need for the development of novel clinical risk stratification tools that reflect risk factors to which ethnic minorities are predominantly predisposed.

Source-Medindia