Unusual trajectory of a bullet from the shoulder to the brain: an emergency department perspective on finding a missing bullet.

Terminal ballistics continues to struggle with bullet trajectory reconstruction and interpretation. This is a case of a young man presented with a very unusual trajectory of a bullet from the left shoulder to the brain parenchyma. The single wound and altered mentation prompted a CT head and neck scan, which revealed a retained bullet in the brain parenchyma, traversing from the left shoulder, across the neck and into the brain without causing significant damage to vital organs. We managed the patient conservatively. Emergency physicians dealing with gunshot injuries should thoroughly search for the bullet in cases where only a single wound is present and the bullet is missing, and they should have a basic understanding of the ballistics to understand the mechanism and injury pattern sustained by the bullet. This atypical ballistic trajectory scenario emphasises the need to exercise vigilance in accurately predicting the trajectory when the ballistic route is unknown.

Derivation of the Difficult Airway Physiological Score (DAPS) in adults undergoing endotracheal intubation in the emergency department.

BACKGROUND: Prediction of serious outcomes among patients with physiological instability is crucial in airway management. In this study, we aim to develop a score to predict serious outcomes following intubation in critically ill adults with physiological instability by using clinical and laboratory parameters collected prior to intubation. METHOD: This single-center analytical cross-sectional study was conducted in the Emergency Department from 2016 to 2020. The airway score was derived using the transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD) methodology. To gauge model's performance, the train-test split technique was utilized. The discrete random number generation approach was used to divide the dataset into two groups: development (training) and validation (testing). The validation dataset's instances were used to calculate the final score, and its validity was measured using ROC analysis and area under the curve (AUC). By computing the Youden's J statistic using the metrics sensitivity, specificity, positive predictive value, and negative predictive value, the discriminating factor of the additive score was determined. RESULTS: The mean age of the 1021 patients who needed endotracheal intubations was 52.2 years (± 17.5), and 632 (62%) of them were male. In the development dataset, there were 527 (64.9%) physiologically difficult airways, 298 (36.7%) post-intubation hypotension, 124 (12%) cardiac arrest, 347 (42.7%) shock index > 0.9, and 456 [56.2%] instances of pH < 7.3. On the contrary, in the validation dataset, there were 143 (68.4%) physiologically difficult airways, 33 (15.8%) post-intubation hypotension, 41 (19.6%) cardiac arrest, 87 (41.6%) shock index > 0.9, and 121 (57.9%) had pH < 7.3, respectively. There were 12 variables in the difficult airway physiological score (DAPS), and a DAPS of 9 had an area under the curve of 0.857. The accuracy of DAPS was 77%, the sensitivity was 74%, the specificity was 83.3%, and the positive predictive value was 91%. CONCLUSION: DAPS demonstrated strong discriminating ability for anticipating physiologically challenging airways. The proposed model may be helpful in the clinical setting for screening patients who are at high risk of deterioration.

Learning Urogenital Diseases in Oddity (LUDO)-a gamification-based innovation for learning urogenital diseases in emergency medicine.

Urogenital emergencies demand immediate attention within the field of emergency medicine, encompassing a range of critical conditions from ectopic pregnancies to kidney stones. Timely diagnosis and treatment are vital to prevent potential mortality and morbidity. However, due to the sensitive nature of these disorders and the cultural taboos surrounding them, accessing prompt medical care can be challenging. To bridge this gap, innovative gamification-based learning techniques, such as the Learning Urogenital Diseases in Oddity (LUDO), have been introduced for emergency medicine residents (Chou, What is gamification? Yukai Chou: Gamification and behavioral design, n.d.; Gamification '13: Proceedings of the first international conference on gameful design, research, and applications, 2013).LUDO is a timed, gamified exercise that offers residents an interactive and engaging platform to enhance their clinical knowledge related to urogenital disorders. Adapted from the well-known board game, LUDO fosters learning, collaboration, and cooperation among residents. This format is highly customizable and can be utilized by various learning groups.Participants, emergency medicine residents from different academic years, formed four teams, each distinguished by a unique color. The exercise utilized simple and accessible materials, including a LUDO board, LED stopwatch, laptop, colored hats, and a desk bell. Teams advanced their tokens through the board by correctly answering urogenital disorder-related questions within a specified time frame.LUDO's objectives extended beyond token movement, assessing essential skills such as teamwork, time management, resource utilization, and strategic decision-making. The option to seek external resources, limited to five times per team, added an element of strategy. Facilitators evaluated participants' performance through questionnaires and Likert scales.The results revealed that LUDO effectively promoted teamwork, communication, leadership, and problem-solving among emergency medicine residents. Resident feedback was overwhelmingly positive, with interest in adopting this format for other educational modules. The gamified approach encouraged engagement and motivation, with immediate feedback ensuring continuous learning.In conclusion, the incorporation of the LUDO gamified format provides an enjoyable and interactive learning experience for emergency medicine residents. It enhances engagement, fosters teamwork, and facilitates the rapid assimilation of crucial knowledge related to urogenital diseases. This adaptable approach holds promise for improving resident training in various clinical scenarios.

Prediction of major adverse cardiac events in the emergency department using an artificial neural network with a systematic grid search.

BACKGROUND: The aim of our research was to design and evaluate an Artificial Neural Network (ANN) model using a systemic grid search for the early prediction of major adverse cardiac events (MACE) among patients presenting to the triage of an emergency department. METHODS: This is a single-center, cross-sectional study using electronic health records from January 2017 to December 2020. The research population consists of adults coming to our emergency department triage at Aga Khan University Hospital. The MACE during hospitalization was the main outcome. To enhance the architecture of an ANN using triage data, we used a systematic grid search strategy. Four hidden ANN layers were used, followed by an output layer. Following each hidden layer was back normalization and a dropout layer. MACE was predicted using three binary classifiers: ANN, Random Forests (RF), and logistic regression (LR). The overall accuracy, sensitivity, specificity, precision, and recall of these models were examined. Each model was evaluated using the receiver operating characteristic curve (ROC) and an F1-score with a 95% confidence interval. RESULTS: A total of 97,333 emergency department visits were recorded during the study period, with 33% of patients having cardiovascular symptoms. The mean age was 54.08 (19.18) years old. The MACE was observed in 23,052 (23.7%) of the patients, in-hospital (up to 30 days) mortality in 10,888 (11.2%) patients, and cardiac arrest in 5483 (5.6%) patients. The data used for training and validation were 77,866 and 19,467 in an 80:20 ratio, respectively. The AUC score for MACE with ANN was 0.97, which was greater than RF (0.96) and LR (0.96). Similarly, the precision-recall curve for MACE utilizing ANN was greater (0.94 vs. 0.93 for RF and 0.93 for LR). The sensitivity for MACE prediction using ANN, RF, and LR classifiers was 99.3%, 99.4%, and 99.2%, respectively, with the specificities being 94.5%, 94.2%, and 94.2%, respectively. CONCLUSION: When triage data is used to predict MACE, death, and cardiac arrest, ANN with systemic grid search gives precise and valid outcomes and will benefit in predicting MACE in emergency rooms with limited resources that have to deal with a substantial number of patients.

Financial Literacy in Residency.

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Point of Care Ultrasonographic Life Support in Emergency (PULSE)-a quasi-experimental study.

BACKGROUND: Many physicians use point-of-care ultrasound (PoCUS) in their clinical practice to improve their diagnostic capabilities, accuracy, and timeliness. Over the last two decades, the use of PoCUS in the emergency room has dramatically increased. This study aimed to determine emergency physicians' retention of knowledge and skills after a brief training workshop on a focused ultrasound-guided approach to a patient presenting with undifferentiated shock, shortness of breath, and cardiac arrest in the emergency department of a tertiary care hospital. The secondary aim was to deliver the PoCUS-guided algorithmic approach to manage a patient presenting with undifferentiated shock, respiratory distress, and cardiac arrest in the emergency department. METHODS: A quasi-experimental study was conducted with a single-day Point of Care Ultrasonographic Life Support in Emergency (PULSE) training workshop in October 2021 at the Aga Khan University Hospital, Karachi, Pakistan. A total of 32 participants attended the course, including twenty-one junior residents (PGY 1 and 2) and medical officers with experience of fewer than two years working in different emergency departments of urban tertiary care hospitals across Karachi, Pakistan. Pre- and post-assessment tools comprised a written examination, evaluating participants' knowledge and skills in ultrasound image acquisition and interpretation. Cronbach's alpha was used to calculate the validity of the tool. Results obtained before and after the training session were compared by the McNemar's test. A p value of ≤ 0.05 was considered significant. RESULTS: There was a significant improvement in response to each question pre to post-test after completion of the course (Table 1). The significant change can be seen in questions 7, 8, 13, and 15, with a percentage change of 33.3, 80.9, 42.9, and 47.7. There was a significant improvement in the understanding and knowledge of participants after the training. The scores in the post-test were high compared to the pre-test in each category, i.e., respiratory distress (p < 0.017), cardiac arrest (p < 0.041), basic ultrasound knowledge (p < 0.001), and undifferentiated shock (p < 0.001). CONCLUSION: All participants showed improvement in their knowledge and confidence regarding using PoCUS in life-threatening conditions. Through this study, we have also developed an algorithmic approach to managing undifferentiated shock, respiratory failure, and cardiac arrest. Future studies must assess the effectiveness and feasibility of incorporating these algorithms into clinical practice.

Necrotizing acute pancreatitis with electrocardiogram changes masquerading acute coronary syndrome.

Acute pancreatitis (AP) refers to the acute inflammation of the pancreas; however, if there is concurrent necrosis, it is called necrotizing acute pancreatitis (NAP). The diagnosis is sometimes difficult because it might mimic acute coronary syndrome (ACS). We report a case of a 28-year-old male, who presented to the emergency department (ED) with severe epigastric pain, shortness of breath and diaphoresis for 4-5 h. The initial electrocardiogram (ECG) showed marked sinus bradycardia with an incomplete left bundle branch block. Considering the clinical presentation and ECG changes, he was managed as ACS and was rushed to catheterization laboratory for a coronary angiogram, which was reported normal. Subsequently, his serum pancreatic enzymes were elevated, and computed tomography of the abdomen showed NAP. In ED settings, it is difficult to differentiate between the two, particularly when AP presents with ECG manifestations masquerading as ACS.

To resuscitate or not to resuscitate? The crossroads of ethical decision-making in resuscitation in the emergency department.

Emergency physicians (EPs) working in low-resource settings, where patients mainly bear the cost of healthcare delivery, face many challenges. Emergency care is patient-centered and ethical challenges are numerous in situations where patient autonomy and beneficence are fragile. This review discusses some of the common bioethical issues in the resuscitation and postresuscitation phases of treatment. Solutions are proposed and the necessity for evidence-based ethics and unanimity on ethical standards is emphasized. After a consensus was reached on the structure of the article, smaller groups of authors (2-3) wrote narrative reviews of ethical issues such as patient autonomy and honesty, beneficence and nonmaleficence, dignity, justice, and specific practices and circumstances such as family presence during resuscitation after discussions with senior EPs. Ethical dilemmas were discussed, and solutions were proposed. Cases related to medical decision-making by proxy, financial constraints in management, and resuscitation in the face of medical futility have been discussed. Solutions proposed include the early-stage involvement of hospital ethics committees, financial assurance in place beforehand, and allowing some leverage on a case-to-case basis when care is futile. We recommend developing evidence-based national ethical guidelines and incorporating societal and cultural norms with autonomy, beneficence, nonmaleficence, honesty, and justice principles.

Point-of-care ultrasound training in low-income countries: a need of time.

Point of care ultrasound (POCUS) is "an ultrasonography performed at the bedside in real-time by the treating physician." It is a powerful imaging modality used as an adjunct to physical examination and has gained momentum to become the future stethoscope. By using POCUS, the treating physician performs all image acquisition and interpretation and uses the information immediately to address specific hypotheses and guide the ongoing therapy. There is a shred of solid evidence that POCUS improves the diagnosis and management of acutely unwell patients is expanding rapidly. Due to the rise in the practice of POCUS in clinical medicine, the use of consultative ultrasonographic services has been reduced. The widespread availability of portable ultrasound machines and training an adequate number of clinicians to become competent in performing POCUS is a great challenge. The development of effective competency levels, curriculum, and assessment methods is imperative for the training of POCUS.

Chlorine gas hazardous material incident in Karachi, Pakistan: A clinical experience from an emergency department of a tertiary care hospital.

OBJECTIVE: To determine the clinical characteristics, management and outcomes of patients presenting with chlorine gas exposure in an emergency setting. METHODS: The single-centre, retrospective cross-sectional study was conducted at the emergency department of Aga Khan University Hospital, Karachi, and comprised data of all patients who presented on March 06, 2020, due to acute chlorine gas exposure after a specific industrial accident. Demographic and clinical data was recorded from the medical record files. The association between risk factors and complications was explored. Data was analysed using SPSS 20. RESULTS: There were 51 male patients with a mean age of 33.10±8.37 years. The most commonly affected organ system was respiratory 49(96%), with 43(84.3) having shortness of breath. Eye irritation was found in 44(86.3%) cases and the central nervous system was involved in 14(27.4%). Most of the patients were admitted from the emergency department 36(70%). Regarding treatment, 1(1.9%) patient each required invasive and non-invasive mechanical ventilation. Complications included toxic pneumonitis 3(5.9%) and pneumomediastinum 1(1.7%). No correlation was found between smoking and complications (p>0.05). CONCLUSIONS: Most patients showed complete resolution of symptoms after receiving supportive treatment, while complications were rare and there was no mortality.

Improvement in the diagnosis and practices of emergency healthcare providers for heat emergencies after HEAT (heat emergency awareness & treatment) an educational intervention: a multicenter quasi-experimental study.

BACKGROUND: The incidence of heat emergencies, including heat stroke and heat exhaustion, have increased recently due to climate change. This has affected global health and has become an issue of consideration for human health and well-being. Due to overlapping clinical manifestations with other diseases, and most of these emergencies occurring in an elderly patient, patients with a comorbid condition, or patients on poly medicine, diagnosing and managing them in the emergency department can be challenging. This study assessed whether an educational training on heat emergencies, defined as heat intervention in our study, could improve the diagnosis and management practices of ED healthcare providers in the ED setting. METHODS: A quasi-experimental study was conducted in the EDs of four hospitals in Karachi, Pakistan. Eight thousand two hundred three (8203) patients were enrolled at the ED triage based on symptoms of heat emergencies. The pre-intervention data were collected from May to July 2017, while the post-intervention data were collected from May to July 2018. The HEAT intervention, consisting of educational activities targeted toward ED healthcare providers, was implemented in April 2018. The outcomes assessed were improved recognition-measured by increased frequency of diagnosing heat emergencies and improved management-measured by increased temperature monitoring, external cooling measures, and intravenous fluids in the post-intervention period compared to pre-intervention. RESULTS: Four thousand one hundred eighty-two patients were enrolled in the pre-intervention period and 4022 in the post-intervention period, with at least one symptom falling under the criteria for diagnosis of a heat emergency. The diagnosis rate improved from 3% (n = 125/4181) to 7.5% (n = 7.5/4022) (p-value < 0.001), temperature monitoring improved from 0.9% (n = 41/4181) to 13% (n = 496/4022) (p-value < 0.001) and external cooling measure (water sponging) improved from 1.3% (n = 89/4181) to 3.4% (n = 210/4022) (p-value < 0.001) after the administration of the HEAT intervention. CONCLUSION: The HEAT intervention in our study improved ED healthcare providers' approach towards diagnosis and management practices of patients presenting with health emergencies (heat stroke or heat exhaustion) in the ED setting. The findings support the case of training ED healthcare providers to address emerging health issues due to rising temperatures/ climate change using standardized treatment algorithms.

Trends in mortality related to unintentional poisoning in the South Asian region from 1990 to 2019: analysis of data from the Global Burden of Disease Study.

OBJECTIVE: This study aimed to estimate the burden of unintentional poisoning in South Asian countries from 1999 to 2019. DESIGN: An ecological study conducted at the regional level for South Asian countries, based on data from the Global Burden of Disease Study 2019. SETTING: We extracted unintentional poisoning data from the Global Burden of Disease Study data set from 1990 to 2019 to assess trends in mortality, disability-adjusted life-years (DALYs), years of life lost, years lived with disability (YLDs) and causative agents in South Asian countries (Bangladesh, Bhutan, India, Nepal and Pakistan). OUTCOME MEASURES: We determined the per cent change and 95% CI for the period between 1990 and 2019 by age, gender and country. We also conducted Poisson regression to measure the percentage change in the rate per year. RESULTS: The absolute number of deaths due to unintentional poisoning in South Asia decreased (-32.6%) from 10 558 deaths in 1990 to 7112 deaths in 2019. The age standardised death rate from unintentional poisoning in South Asia has seen a downward trend (-55.88%), declining from 0.87 (0.67-1.01) age-standardised per 100 000 population in 1990 to 0.41 (0.34-0.47) in 2019. Among age groups, under 9 years and 10-19 years have seen downward trends for death and DALYs, accounting for -93.5% and -38.3%, respectively. YLDs have seen an upward trend (5.9%), increasing from 10 461.7 per 100 000 in 1990 to 11 084 per 100 000 in 2019. YLDs in women increased by 7.4%, from 11 558.2 per 100 000 to 12 418.3 per 100 000. The incidence rate ratios (IRRs) adjusted by all age groups and gender for DALYs in all South Asian countries has reduced significantly (IRR 0.97, 95% CI 0.96 to 0.97) from 1990 to 2019. CONCLUSION: This study showed reduction in death and DALYs due to unintentional poisoning in South Asia except YLDs which is showing an increasing trend. Public health systems should continue efforts to minimise and prevent disabilities arising from unintentional poisoning in South Asia.

Sigmoid colon perforation secondary to blunt abdominal trauma from cow hoof.

INTRODUCTION: Abdominal discomfort is one of the most prevalent complaints presented to the emergency department. When making a clinical diagnosis, blunt trauma with substantial visceral injuries requires a high index of suspicion. CASE PRESENTATION: The patient went to the emergency room after experiencing lower abdomen discomfort and a fever for two days. He was 40 years old. He says he was injured two days earlier when a cow foot landed on his stomach, causing mild blunt injuries. When examined, he is delicate all the way down in his lower belly. Results from the lab indicated a higher-than-normal total leucocyte count. Echogenic bowel thickening is seen on point-of-care ultrasonography (PoCUS) of the lower abdomen. Abdominal CT with contrast revealed oedema, heterogeneous enhancement, and a focal stretch of thickened circumferential mural including the sigmoid colon and peri-colonic fat stranding. Biopsy results from a sigmoidoscopy revealed significant sigmoid colon constriction and localized areas of active inflammation. Stricture development after a Sigmoid hole caused by a cow foot injury is an extremely unusual occurrence. DISCUSSION: This case emphasizes the need of a thorough history and physical examination, especially in a high-pressure emergency scenario, and the value of using ultrasonography at the bedside to make a definitive diagnosis and improve patient care. CONCLUSION: Regardless of the severity of abdominal damage caused by cattle collision, early imaging should be explored since delaying action might result in poor results.

Mental health assessment of healthcare workers in the emergency department of a low middle-income country during COVID-19 pandemic.

INTRODUCTION: Emergency department (ED) healthcare workers in Pakistan during the COVID-19 pandemic are facing an acute rise in mental illnesses. In this study, the authors aim to assess the frequency of anxiety and depression among healthcare workers in the ED. METHODS: A cross-sectional online google form-based survey was conducted in the ED of Aga Khan University Hospital, Karachi, Pakistan between July and August 2020. The Hospital Anxiety and Depression (HAD) scale was used for mental illness assessment among ED healthcare workers. Descriptive analysis of grading as per the Likert scale is done through frequencies, means, and standard deviations. Categorical variables were expressed as frequency (%). Mann-Whitney U test was used to compare scores of various groups and sub-groups and the Chi-square test was used to assess the association of depression and anxiety categories among the groups. RESULTS: In the ED, 127 healthcare workers (physicians and nurses) were included in this survey. The median depression score was 8 (IQR 6-10) with 21% (27) falling under depression and 39% (50) under borderline depression. The median anxiety score was 9 (IQR 7-12) with 33% (42) having abnormal, and 38% (48) having borderline anxiety. Healthcare workers working for > 45 h per week have odds of 3.62 [1.374-9.549] of developing depression compared to anxiety with a p-value of 0.009. Similarly, nurses and medical officers develop depression with odds of 2.18 [1.016-4.686] p-value 0.045 and 5.18 [0.197-1.02] p-value 0.002, respectively. CONCLUSION: ED healthcare workers during the COVID-19 pandemic suffered high levels of anxiety and depression, which is a matter of concern. Comprehensive support and training of ED healthcare workers are needed to promote physical and mental well-being and to develop guidelines that should be used during situations that can affect the mental health of healthcare workers.

Internet of Things (IoT) in Assessing Physician Wellness.

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Predictors of abnormal electroencephalogram and neuroimaging in children presenting to the emergency department with new-onset afebrile seizures.

BACKGROUND: Electroencephalogram and neuroimaging in pediatric patients with new-onset afebrile seizures are performed to detect any underlying pathological severe condition that may require emergent neuro-intervention and guide prognosis. This study aims to determine the predictors of abnormal EEG and neuroimaging in children presenting to the emergency department with new-onset afebrile seizures. METHODS: This single-center cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan, from July 01, 2019, to June 30, 2021. All patients aged one month to 18 years who presented with new-onset afebrile seizures were included. Demographic and clinical data were recorded, including age, gender, seizure type, duration of seizure, associated signs and symptoms, and disposition. Multivariable regression analysis was applied to determine the predictors of abnormal EEG and CT scan or MRI findings. RESULTS: Out of 201 participants, most patients were in the infantile age group (41.3%), with an equal gender distribution. The most common type of seizure was generalized onset 152 (75.6%). EEG was performed on a total of 126 patients (62.7%) and out of these patients, 67 patients (53.1%) had abnormal findings. In a multivariable analysis, the age group of 5 to 10 years and seizure duration of more than 5 min were significantly associated with higher odds of abnormal EEG findings. In contrast, only the focal onset of seizure was significantly associated with higher odds of abnormal neuroimaging findings. CONCLUSION: The study emphasizes the need for a protocol regarding the performance of EEG and neuroimaging in children presenting to the ED with new-onset afebrile seizures that would aid emergency physicians in the direction of appropriate management, thus ensuring a better quality of patient care and outcomes.

Clinical audit on indications and technique of male urethral catheterization in emergency department of a tertiary care hospital.

Urethral catheterization (UC) is a common procedure done in the Emergency Department of a hospital. The main indications for a UC are relieving acute urinary retention and bladder outlet obstruction. This cross-sectional audit was carried out between July 2019 to February 2020, in the Emergency Department (ED). All male patients aged 18 years and above, in whom UC was performed, were included in the audit. A total of 81 male patients were surveyed. Although, sterilized technique was maintained by using sterile gloves and pyodine but hand hygiene (sterilization or hand wash) was not performed before the procedure 80% of times. CDC hand hygiene guidelines were distributed to promote hand hygiene. What do we already know about this topic ? The Lippincott guidelines are considered gold standard which includes hand hygiene as an important element of urinary catheterization UC. The CDC Center of Disease Control CDC promotes the use of mandatory gloves and generous hand sanitizing before procedures. How does your research contribute to the field For continuous improvement and patient focused practice, we must audit the technique of nursing staff, doctors and health care assistants who are involved in insertion and ordering of catheters to provide quality health care and avoid unnecessary catheterization [1]. The aim of this study was to audit the appropriateness of usage of urinary catheters by the healthcare staff and, their technique of insertion and indications for urinary catheterization. What are your research's implications towards theory, practice, or policy? Hand hygiene is an important element of patient care. If done properly it can prevent several hospital-acquired infections. Heathcare facilities must audit their staff on regular basis and provide refreshers and promote the use of proper hand hygiene before urinary catheterization.

Chief Resident Election of Emergency Department (CREED) - An innovative approach to fair and bias-free chief resident selection in a residency program.

Emergency medicine has transitioned from developing to a developed specialty in Pakistan. It is gaining recognition in the national and international arena. Residency in emergency medicine is a tough pathway in which a resident learns and is assessed at multiple levels. The attributes that are needed for an empathetic emergency medicine physician are multifaceted. Chief resident selection has been an important step in postgraduate residency. The selection process was traditionally based on seniority and academic achievements with no consideration for soft skills. In the current write-up, we are proposing an evidence-base sequential chief resident selection process called Chief Resident Election of Emergency Department (CREED). The program was developed keeping in consideration the traditional method of election and interviews with the incorporation of reflexive, leadership, communication, and collaboration skills.

Development of COVID-19 severity assessment score in adults presenting with COVID-19 to the emergency department.

BACKGROUND: Critically-ill Covid-19 patients require extensive resources which can overburden a healthcare system already under strain due to a pandemic. A good disease severity prediction score can help allocate resources to where they are needed most. OBJECTIVES: We developed a Covid-19 Severity Assessment Score (CoSAS) to predict those patients likely to suffer from mortalities within 28 days of hospital admission. We also compared this score to Quick Sequential Organ Failure Assessment (qSOFA) in adults. METHODS: CoSAS includes the following 10 components: Age, gender, Clinical Frailty Score, number of comorbidities, Ferritin level, D-dimer level, neutrophil/lymphocyte ratio, C-reactive Protein levels, systolic blood pressure and oxygen saturation. Our study was a single center study with data collected via chart review and phone calls. 309 patients were included in the study. RESULTS: CoSAS proved to be a good score to predict Covid-19 mortality with an Area under the Curve (AUC) of 0.78. It also proved better than qSOFA (AUC of 0.70). More studies are needed to externally validate CoSAS. CONCLUSION: CoSAS is an accurate score to predict Covid-19 mortality in the Pakistani population.