The severity of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the associated coronavirus disease 2019 (COVID-19) varies strongly and may progress in stages. To assess the probability of COVID-19 diagnosis and the likelihood of a progressive disease and to assist decision making regarding hospitalization, the AIFELL score may be useful (see publication and calculator below). Questions concerning the score can be addressed to Ian Levenfus or Macé Schuurmans using the email  i n f o @ a i f e l l . n e t.

The AIFELL score is calculated by counting the number of positive criteria met at initial presentation in the emergency room, whereas each criterion equals one point (Score range 0 to 6 points) [1]. A form to calculate the score easly using checkboxes is presented below

 

Components of the AIFELL score

A

Altered sense of smell/taste

Any changes or impairments of the sense of smell/taste since onset of any current symptoms or directly before onset of respiratory/general symptoms.

I

Inflammation (C-reactive protein ≥ 30 mg/l)

Infiltrates

Any radiological infiltrates in chest X-ray or thoracic CT (no differentiation between unilateral or bilateral infiltrates).

F

Fever (≥ 38.0°C) or History of Fever last 3 days

Auricular measurement. If no fever: Antipyretics taken before ER?

EL

Elevated Lactate dehydrogenase (LDH) levels (> 85th percentile of the maximal value of the reference range) or non-measurable result (due to hemolysis)

L

Lymphocytopenia (absolute count < 1.45 G/l)

 

[1] Levenfus I., Ullmann E., Battegay E., Schuurmans MM. Triage tool for suspected COVID-19 patients in the emergency room: AIFELL score. Brazilian J Infect Dis. 2020. Doi: 10.1016/j.bjid.2020.07.003. https://www.bjid.org.br/en-triage-tool-for-suspected-covid-19-articulo-S1413867020301021

COVID-19 Stages

Supplementary Figure S.1 from the aforementioned publication by Levenfus et al. (2020): COVID-19 Stages as suggested by Siddiqi und Mehra [2]. In COVID-19 Stage II, a hospitalization should be considered. Stage III patients usually need ICU admission.

[2] Siddiqi HK., Mehra MR. COVID-19 Illness in Native and Immunosuppressed States: A Clinical-Therapeutic Staging Proposal. J Hear Lung Transplant. 2020. Doi: 10.1016/j.healun.2020.03.012.
 

 

AIFELL Score Calculator:

Any changes or impairments of the sense of smell/taste since onset of any current symptoms or directly before onset of respiratory/general symptoms.
Any radiological infiltrates in chest X-ray or thoracic CT (no differentiation between unilateral or bilateral infiltrates).
Auricular measurement. If no fever: Antipyretics taken before ER?
0
Interpretation >

AIFELL score

(points)

Interpretation

3 – 6

High probability of COVID-19 evolving to Stages II and III 

0 – 2

Lower probability of COVID-19 evolving to Stages II and III.

The score is not intended to identify asymptomatic or oligosymptomatic SARS-CoV-2 infections (COVID-19 Stage I).