A NOVEL clinical tool, the CROSS score, has been developed to accurately predict the risk of intensive care unit (ICU) admission for patients with COVID-19 who present at the emergency room. The tool, which is calculator-free, outperforms existing risk evaluation methods and offers clinicians a practical way to assess critically ill patients.
The study analysed data from a nationwide German cohort spanning March 2020–January 2023. ICU admission rates within seven days were consistent across cohorts: 30.8% in the northern German derivation cohort (n=1,295, median age: 60 years, 38.1% female), 28.1% in the southern German evaluation cohort (n=1,123, median age: 58 years, 36.9% female), and 30.3% in an externally validated Colombian cohort (n=780, median age: 57 years, 38.8% female).
The CROSS score, a simple 11-point system, incorporates Confusion, Respiratory rate, Oxygen saturation (with or without supplemental oxygen), and oxygen Supplementation. It demonstrated strong predictive performance, with an area under the curve of 0.77 in the evaluation cohort and 0.69 in the Colombian cohort. The score also showed good calibration and superior clinical utility compared to existing tools, particularly those designed to predict mortality.
Importantly, mortality-predicting tools performed poorly in identifying ICU admission risk, highlighting the need for a specialised approach like CROSS. The study authors emphasised the tool’s ease of use, as it requires no calculators or complex algorithms, making it suitable for rapid decision-making in busy ER settings.
The CROSS score’s reliable predictions could significantly impact patient care, allowing clinicians to prioritise resources and initiate timely interventions for high-risk patients. However, the study notes that further research is necessary to evaluate the score’s generalisability in diverse healthcare environments.
Ada Enesco, EMJ
Reference
Xiang W et al. Predicting the risk of intensive care unit admission in patients with COVID-19 presenting in the emergency room: development and evaluation of the CROSS score. Clin Infect Dis. 2025; DOI:10.1093/cid/ciaf006.
