The RECOVER registry is the result of a grass‐roots effort of a consortium of 45 emergency medicine clinician investigators from 27 US states representing both community and academic centers. The registry had 2 preliminary aims. First, creation of a quantitative pretest probability scoring system to predict a positive SARS‐CoV‐2 test, and relatedly the derivation and internal validation of a prediction rule to identify those at very low probability of disease (COVID‐19 Rule Out Criteria‐CORC rule). The second aim is the derivation and internal validation of a set of criteria to predict the development of severe COVID‐19. Rationale for the RECOVER registry hinges on the fact that the ED represents a pivotal site for syndromic surveillance because of the high volume of undifferentiated patients and the spectrum of illness that can be captured early in the disease course. In 2016, US EDs had >145 million encounters each year, and we anticipated that millions of ED patients would be evaluated for suspected COVID‐19 in 2020.13 Additionally, because the ED interfaces with both outpatient and inpatient medical care, the critical question of SARS‐CoV‐2 infection status affects decisions to admit or discharge the patient, return to work, need for home isolation, and the location of hospital admission.
Recognizing in March of 2020 that a vaccine was at least 12 months away, and SARS‐CoV‐2 would likely remain endemic in the years to come, the first aim focused on developing simple clinical criteria to exclude COVID‐19 at the bedside, without the need for blood or radiographic testing. In many EDs, the turnaround time for laboratory testing for SARS‐CoV‐2 nucleic acid takes longer than 24 hours and rapid point‐of‐care assays have been hampered by low sensitivity, with one systematic review finding the sensitivity in pooled data at only 56% for antigen tests.7 Reports of low test sensitivity for swab reverse transcriptase polymerase chain reaction (rtPCR) tests, and tests that use other nucleic amplification techniques, have raised concern.4 , 6 , 14 Without specific reliable exclusionary criteria, emergency care clinicians cannot make expeditious decisions for each of the tens of millions of ED patients with symptoms consistent with COVID‐19, nor can the emergency care system operate efficiently with the potential need to order a SARS‐CoV‐2 test for each of these patients.
Recognizing in March of 2020 that a vaccine was at least 12 months away, and SARS‐CoV‐2 would likely remain endemic in the years to come, the first aim focused on developing simple clinical criteria to exclude COVID‐19 at the bedside, without the need for blood or radiographic testing. In many EDs, the turnaround time for laboratory testing for SARS‐CoV‐2 nucleic acid takes longer than 24 hours and rapid point‐of‐care assays have been hampered by low sensitivity, with one systematic review finding the sensitivity in pooled data at only 56% for antigen tests.