Document Type : Brief Report


1 General Practitioner, Qom University of Medical Sciences, Qom, Iran

2 Department of Family and Community Medicine, School of Medicine, Qom University of Medical Sciences, Qom, Iran

3 Rafsanjan University of Medical Sciences, Rafsanjan, Iran

4 Medical Research Committee, Qom University of Medical Sciences, Qom, Iran

5 Department of Internal Medicine, School of Medicine, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran


Objective: Since the outbreak of coronavirus disease 2019 (COVID-19), the triage of
patients diagnosed with corona virus has been a very important issue. The aim of this
study was to introduce a triage scoring system according to the clinical and para-clinical
findings of patients in order to be admitted or discharged with COVID-19.
Methods: After confirming the positive polymerase chain reaction (PCR) test for patients,
we used a scoring system which included: the age of patient (less than 40 years and >40
years), early vital signs at the time of admission, lab tests including C-reactive protein (CRP),
white blood count (WBC), lactate dehydrogenase (LDH), D-dimer, chest imaging findings,
comorbidity and shortness of breath.
Results: The clinical score obtained for each variable in this scoring system was a number
between 0 and 3. The total score was a minimum of 0 and a maximum of 17. A higher score
indicated an increase in the intensity and the need for intensive care. These scores were
classified into 3 groups: 0-4, 5-10 and above 10. In the next stage, patients were divided
into three groups: mild, moderate and severe. In this regard, patients with mild symptoms
were suggested to receive home quarantine and home treatment, patients with moderate
symptoms were recommended hospitalization and medical care, and finally patients with
severe symptoms were inclined to intensive care.
Conclusion: In order to treat and manage patients with COVID-19, it is necessary to pay
particular attention to clinical and para-clinical findings and prioritize these findings based
on the severity and the condition of patients.


Main Subjects

  1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China,
    2019. N Engl J Med. 2020; 382(8): 727-33. doi: 10.1056/NEJMoa2001017.
    2. Salunke AA, Nandy K, Pathak SK, Shah J, Kamani M, Kotakotta V, et al. Impact of COVID-19 in cancer patients
    on severity of disease and fatal outcomes: a systematic review and meta-analysis. Diabetes Metab Syndr. 2020;
    14(5): 1431-7. doi: 10.1016/j.dsx.2020.07.037.
    3. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of 2019 novel coronavirus infection
    in China. MedRxiv. 2020. doi: 10.1101/2020.02.06.20020974.
    4. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA.2020; 323(11): 1061-1069. doi: 10.1001/jama.2020.1585.
    5. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of
    2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020; 395(10223): 507-13. doi:
    6. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395(10223): 497-506. doi:10.1016/S0140-6736(20)30183-5.
    7. CDC. Interim infection prevention and control recommendations for hospitalized patients with Middle
    East respiratory syndrome coronavirus (MERS-CoV). Availeble from:
    infection-prevention-control.html. [cited 2015 Jul 20]. 2017.
    8. Memberships M, Join T. Guidance on Coronavirus Disease 2019 (COVID-19) for Transplant Clinicians. Availeble
    from: on-2019-novel-coronavirus-2019-ncovfortransplant-id-clinicians. Updated 8 June 2020.
    9. Salunke AA, Pathak SK, Dhanwate A, Warikoo V, Nandy K, Mendhe H, et al. A proposed ABCD scoring system
    for patient’s self assessment and at emergency department with symptoms of COVID-19. Diabetes Metab Syndr. 2020; 14(5): 1495-501. doi: 10.1016/j.dsx.2020.07.053.
    10. Shi Y, Yu X, Zhao H, Wang H, Zhao R, Sheng J. Host susceptibility to severe COVID-19 and establishment of a
    host risk score: findings of 487 cases outside Wuhan. Crit Care. 2020;24(1):108. doi: 10.1186/s13054-020-2833-7.
  2. 11. Duca A, Piva S, Focà E, Latronico N, Rizzi M. Calculated decisions: Brescia-COVID Respiratory Severity Scale
    (BCRSS)/algorithm. Emerg Med Pract. 2020; 22(5 Suppl):CD1-2.
    12. Ji D, Zhang D, Xu J, Chen Z, Yang T, Zhao P, et al. Prediction for progression risk in patients with COVID-19 pneumonia: the CALL Score. Clin Infect Dis. 2020; 71(6): 1393-9. doi:10.1093/cid/ciaa414.
    13. Wallis LA. COVID-19 Severity Scoring Tool for low resourced settings. Afr J Emerg Med. 2020. doi: 10.1016/j.afjem.2020.03.002.
    14. Hu H, Yao N, Qiu Y. Comparing rapid scoring systems in mortality prediction of Critically Ill patients with novel
    coronavirus disease. Acad Emerg Med. 2020; 27(6): 461-8. doi: 10.1111/acem.13992.