Sort and Sieve: Pre-Triage Screening of Patients with Suspected COVID-19 in the Emergency Department.

Kirsten R.C Hensgens,Joop P Van Den Bergh,Frits H.M Van Osch,Anita W Lekx,Caroline E Wyers,Dennis G Barten,Inge H.T Van Rensen,Lieve H.H Knarren

doi:10.3390/ijerph18179271

Kirsten R.C Hensgens, Joop P Van Den Bergh + Show 6 more

Open Access

https://doi.org/10.3390/ijerph18179271

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Abstract

Introduction. To reduce the risk of nosocomial transmission, suspected COVID-19 patients entering the Emergency Department (ED) were assigned to a high-risk (ED) or low-risk (acute medical unit, AMU) area based on symptoms, travel and contact history. The objective of this study was to evaluate the performance of our pre-triage screening method and to analyse the characteristics of initially undetected COVID-19 patients. Methods. This was a retrospective, observational, single centre study. Patients ≥ 18 years visiting the AMU-ED between 17 March and 17 April 2020 were included. Primary outcome was the (correct) number of COVID-19 patients assigned to the AMU or ED. Results. In total, 1287 patients visited the AMU-ED: 525 (40.8%) AMU, 762 (59.2%) ED. Within the ED group, 304 (64.3%) of 473 tested patients were COVID-19 positive, compared to 13 (46.4%) of 28 tested patients in the AMU group. Our pre-triage screening accuracy was 63.7%. Of the 13 COVID-19 patients who were initially assigned to the AMU, all patients were ≥65 years of age and the majority presented with gastro-intestinal or non-specific symptoms. Conclusion. Older COVID-19 patients presenting with non-specific symptoms were more likely to remain undetected. ED screening protocols should therefore also include non-specific symptoms, particularly in older patients.

Highlights

BackgroundThe COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2), has placed an ongoing burden on healthcare systems globally [1,2]
With this study we aimed to provide more insight into the COVID-19 patients that are likely to remain undetected upon Emergency Department (ED) entrance, thereby optimising ED screening
The conjoined acute medical unit (AMU)-ED was segregated into a high-risk and a low-risk area: both medically unstable and COVID-19 suspected patients were assigned to the ED and isolated, whereas low-acuity, COVID-19 non-suspected patients were assigned to the AMU

Summary

Introduction

BackgroundThe COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2), has placed an ongoing burden on healthcare systems globally [1,2]. The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2. EDs are confronted with a surge of severely ill patients, they play an indispensable role in the early identification and subsequent segregation of COVID-19 suspected patients [8,9]. This screening process is crucial to lower the risk of nosocomial transmission and to guard the safety of patients and staff [10,11].

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