Brescia-COVID Respiratory Severity Scale (BCRSS)/Algorithm
Step-wise management approach to COVID-19 patients based on clinical severity as of June 2, 2020.
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Launched during COVID-19 crisis. Not externally validated. Use with caution; this is being used in Italy for assessment, trending, and treatment recommendations.
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This algorithm is a step-wise approach to managing patients with confirmed/presumed COVID-19 pneumonia.
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If not intubated, follow management and then each 4 testing criteria should be repeated to assess for improvement or deterioration. Repetition frequency based on clinical judgment to downgrade/upgrade score.
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Not only is the management important; the numerical score is used to easily compare and summarize patients to treating clinicians.
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NIV concerning for aerosolization; included in score due to ventilator scarcity in Italy.
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Healthcare workers must be aware that COVID-19 information is rapidly changing; MDCalc will attempt to update this score as frequently as possible to keep up with the rapidly changing nature of this pandemic.
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While this score certainly would indicate increasing levels of respiratory severity, one's local hospital recommendations or drug availability may provide different recommendations for treatment.
This score is meant to be dynamic and frequently reassessed and re-scored after interventions; frequency of reassessment is by clinical judgment. A brand new patient in the ED may need to be reassessed every 15 minutes, for example, while a stable patient on the medical floor may only need reassessment every 6-12 hours. If a patient is assigned a new score based on these criteria, the medical and respiratory management should then change as well.
Patients requiring significant levels of oxygen, tachypnea, or ventilatory support are obviously at extremely high risk for clinical decompensation and death.