[page 38] [Emergency Care Journal 2021; 17:9859] Emergency Care Journal 2021; volume 17:9859 Abstract COVID-19 patients require early treatment and admission to an appropriate care setting, considering possible rapid and unpre- dictable to Severe Acute Respiratory Syndrome. A flow-chart was developed by a multidisciplinary team of Emergency Department (ED) clinicians, intensivists and radiologists aiming to provide tools for disease severity stratification, appropriate ventilation strategy and hospitalization setting identification. We conducted a retrospective application of our model on 313 hospitalized patients at Pisa University Hospital including 222 patients admitted to ED for respiratory failure between March and April 2020. Risk strati- fication score was based on respiratory and chest imaging param- eters, while management strategy on comorbidities and age. Age, comorbidities, clinical respiratory and arterial blood gas parame- ters, semi-quantitative chest computed tomography score were sig- nificant predictors of mortality (p<0.05). Mortality rate was higher in patients treated in intensive care units (26.5%) and undergoing endo-tracheal intubation (32.7%), compared to medical area (21.3%). We verified a good concordance (81.7%) between the proposed model and actual evaluation in ED. Outcomes analysis of subgroups of patients homogeneous for baseline features allowed to verify safety of our model: in non-elderly and/or non-comorbid patients (15% mortality) our scheme overestimates the risk in 30% of cases, but it suggests non-intensive management in patients with reduced functional reserve, elderly and with comorbidities (50% mortality). Correct management of respiratory failure COVID-19 patients is crucial in this unexpected pandemic. Our flow-chart, despite retrospectively application in small sample, could repre- sents a valid and safe proposal for evaluation in ED. Introduction Background The rapid spread of CO-rona VI-rus D-isease 2019 (COVID- 19) cases resulted in overcrowd of Emergency Departments (ED). 1 Even though most patients with COVID-19 infection has minor symptoms and good prognosis, a considerable group shows a Severe Acute Respiratory Syndrome Coronavirus 2 related (SARS-CoV-2) 2 , which requires early treatment and admission to an appropriate care setting, in order to avoid negative outcomes. 1,3 The official guidelines of Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care (Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva, SIAARTI), published on the 6 th of March 2020, drew physician’s attention to an epidemic scenario of such magnitude that might cause an imbal- ance between the population real clinical needs and the effective availability of Intensive Care Unit (ICU) resources. 4 Considering this possible derangement, the use of appropriate clinical tools is Correspondence: Greta Barbieri, Department of Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Via Savi 10, 56126 Pisa, Italy. Tel.: +39.3470104897 E-mail: greta.barbieri@phd.unipi.it Key words: COVID-19; ventilation; pneumonia; emergency depart- ment; management strategy. Conflict of interest: The authors declare no conflict of interests. GB and LG are members of ECJ editorial board. Contributions: GB was responsible for drafting, data analysis, and reviewing the manuscript. PM, LG, and AC designed the study and revised the manuscript. SC was responsible for data collection. SS, FC, FF, MF, FA, MS and MT revised the manuscript. Availability of data and material: The data are available from the authors upon reasonable request. Ethics approval and consent to participate: Not applicable. Informed consent: Not applicable. Conference presentation: The work was presented as oral communica- tion at Webinar “L’approccio del DEA alla luce delle più recenti Linee Guida” (7 November 2020, Pisa, Italy) and at Webinar “Conseguenze a breve e lungo termine del COVID” (11 Novembre 2021, Pisa, Italy). Received for publication: 16 May 2019. Revision received: 29 November 2021. Accepted for publication: 29 November 2021. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). © Copyright: the Author(s), 2021 Licensee PAGEPress, Italy Emergency Care Journal 2021; 17:9859 doi:10.4081/ecj.2021.9859 SARS-CoV-2 management in emergency department: Risk stratification and care setting identification proposal based on first pandemic wave in Pisa University Hospital Greta Barbieri, 1,2 Alessandro Cipriano, 2 Stella Carrara, 3 Stefano Spinelli, 2 Francesco Cinotti, 2 Francesca Foltran, 4 Matteo Filippi, 4 Ferruccio Aquilini, 4 Michele Tonerini, 5 Massimo Santini, 2 Paolo Malacarne, 3 Lorenzo Ghiadoni 2,6 1 Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa; 2 Emergency Medicine Department; 3 Department of Anaesthesia and Critical Care Medicine; 4 Medical Directional Department; 5 Department of Emergency Radiology, Pisa University Hospital, Pisa; 6 Department of Clinical and Experimental Medicine, University of Pisa, Italy Non commercial use only