Read on Twitter
Our new paper (important one). RECAP-v0 study.
RECAP = REmote Covid Assessment in Primary Care.
Iâll explain in this thread.
https://bmjopen.bmj.com/content/10/11/e042626
1/
RECAP = REmote Covid Assessment in Primary Care.
Iâll explain in this thread.
https://bmjopen.bmj.com/content/10/11/e042626
1/
Back in March/April I became worried that people with Covid-19 symptoms were being reassured and told to stay at home. Telephone triage staff were using questionable ways of assessing how ill people were and their likelihood of deteriorating.
2/
2/
Hospitals were overstretched. There was pressure on primary care and ambulance services to keep people out of hospital. This led to over-use of instruments like Roth score. https://www.cebm.net/covid-19/roth-score-not-recommended-to-assess-breathlessness-over-the-phone/
3/
3/
NEWS2 was widely used in hospital but hadnât been designed or validated as a pre-hospital decision tool. Some described it as a âpre-mortuaryâ score.
https://www.cebm.net/covid-19/should-we-use-the-news-or-news2-score-when-assessing-patients-with-possible-covid-19-in-primary-care/
4/
https://www.cebm.net/covid-19/should-we-use-the-news-or-news2-score-when-assessing-patients-with-possible-covid-19-in-primary-care/
4/
Many prediction scores have been developed for Covid-19. 4C is used in hospital (may help decide who needs ITU), but requires blood tests which arenât easily available in primary care. Itâs no use when consulting over the phone. https://www.bmj.com/content/370/bmj.m3339
5/
5/
QCOVID is a new, validated, score which predicts likely severity of Covid-19 based on items (e.g. age, comorbidities) on the patientâs GP record. But it does not include any acute data so isnât designed to assess how sick the patient currently is.
https://www.bmj.com/content/371/bmj.m3731
6/
https://www.bmj.com/content/371/bmj.m3731
6/
If you use QCOVID to decide whether to send someone to hospital, youâre likely to miss the young person without risk factors who (unluckily) has very serious illness. Youâre also likely to send in too many people (eg care home patients) who donât have Covid.
7/
7/
RECAP was developed using extensive qualitative research â focus groups and interviews with clinicians (GPs, nurses, paramedics) and patients (people who had had the experience of calling NHS111 with deteriorating Covid-19).
8/
8/
We also did an evidence review and a 4-round Delphi panel in which clinicians hammered out the wording and cut-off values for each item. And we got them to apply the items to fictional vignettes which weâd deliberately constructed as âgreyâ (difficult) cases.
9/
9/
Weâve ended up with a list of items which has whatâs called âface validityâ â most clinicians look at it and say yeah seems about right. But this list has not yet been validated (does it *actually* predict outcome)? Weâre testing that now.
10/
10/
Weâre recruiting 3000 patients (via their GPs) with new symptoms of Covid-19 to agree to data linkage where we link the RECAP items with outcomes (hospital admission, ITU admission, death).
11/
11/
Iâm a qualitative researcher so my contribution to RECAP is largely finished. The quantitative data linkage study (currently ongoing) is led by @bcdelaney1 and @lusignan_s Itâs a partnership between Oxford and Imperial BRCs, funded by UKRI and Community Jameel Imperial fund.
12/
12/
You can read more about the validation phase of the RECAP study here. If youâre a GP you can find out how to join the study (and get paid to recruit patients).
https://imperialbrc.nihr.ac.uk/research/covid-19/covid-19-ongoing-studies/recap/
13/
https://imperialbrc.nihr.ac.uk/research/covid-19/covid-19-ongoing-studies/recap/
13/
We made a video to explain the ongoing RECAP validation study here:
https://imperialbrc.nihr.ac.uk/research/covid-19/covid-19-ongoing-studies/recap/recap-video/
end/
https://imperialbrc.nihr.ac.uk/research/covid-19/covid-19-ongoing-studies/recap/recap-video/
end/
PS the final (not yet validated) RECAP items are here. We hope that the final score, once validated (likely to be tweaked and hopefully shortened), will save lives.
