Potential Solutions for Triage, Screening, and Severity Scoring of Potentially-Positive COVID-19 Patients in Low-Resource Settings: A Scoping Review

Abstract

Background: Purposefully designed and validated screening, triage, and severity scoring tools are needed to reduce mortality of COVID-19 in low-resource settings (LRS). This review aimed to identify currently proposed and/or implemented methods of screening, triaging, and severity scoring suspected COVID-19 patients upon initial presentation to the healthcare system, and to evaluate the utility of these tools in LRS. Methods: A scoping review was conducted to identify studies describing screening, triage, and severity scoring of suspected COVID-19 patients published between December 12, 2019 and September 01, 2020. Extracted information included clinical features, use of laboratory and imaging studies, and relevant tool validation data. Findings: The initial search strategy yielded 14,350 articles. A total of 93 manuscripts met inclusion criteria. Most studies were from China (n=37, 39.8%) or the United States (n=15, 16·1%). In total, 51 screening, 39 severity scoring tools, and 20 triage tools were described; 13 of these – nine for screening, two for triage, and two for severity scoring – were identified as feasible in LRS and were being used in such settings. A total of 31 studies provided validation data: four prospective and 27 retrospective, with none from low-income and lower-middle-income countries. Interpretation: This study identified a wide range of screening, triage, and severity scoring tools implemented and proposed for suspected COVID-19 patients. No tools were designed and validated in LRS. A tool specific to resource limited context is crucial to reducing mortality in the current pandemic. Funding: No funding was received for this study.Declaration of Interests: The authors declare no competing interests.