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. 2020 Oct 7;9(10):3217.
doi: 10.3390/jcm9103217.

COVID-19 Triage and Test Center: Safety, Feasibility, and Outcomes of Low-Threshold Testing

Gregory Mansella  1 , Marco Rueegg  1 , Andreas F Widmer  2 , Sarah Tschudin-Sutter  2 , Manuel Battegay  2 , Julia Hoff  1 , Kirstine K Søgaard  3   4 , Adrian Egli  3   4 , Bram Stieltjes  5 , Karoline Leuzinger  6   7 , Hans H Hirsch  2   6   7 , Andrea Meienberg  8 , Thilo Burkard  8 , Michael Mayr  8 , Roland Bingisser  1 , Christian H Nickel  1
Affiliations

COVID-19 Triage and Test Center: Safety, Feasibility, and Outcomes of Low-Threshold Testing

Gregory Mansella et al. J Clin Med. .

Abstract

This prospective observational study evaluated the safety and feasibility of a low threshold testing process in a Triage and Test Center (TTC) during the early course of the coronavirus disease 19 (COVID-19) pandemic. In addition, we aimed to identify clinical predictors for a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) swab result. Patients underwent informal triage, standardized history taking, and physician evaluation, only where indicated. Patients were observed for 30 days. Safety was the primary outcome and was defined as a COVID-19-related 30 day re-presentation rate <5% and mortality rate <1% in patients presenting to the TTC. Feasibility was defined as an overruling of informal triage <5%. Among 4815 presentations, 572 (11.9%) were tested positive for SARS-CoV-2, and 4774 were discharged. Mortality at 30-days was 0.04% (2 patients, one of which related to COVID-19). Fever (OR 2.03 [95% CI 1.70;2.42]), myalgia (OR 1.94 [1.63;2.31]), chills (OR 1.77 [1.44;2.16]), headache (OR 1.61 [1.34;1.94]), cough (OR 1.50 [1.24;1.83]), weakness (OR 1.46 [1.21;1.76]), and confusion (OR 1.39 [1.06;1.80]) were associated with test positivity. Re-presentation rate was 8% overall and 1.4% in COVID-19 related re-presentation (69 of 4774). The overruling rate of informal triage was 1.5%. According to our study, a low-threshold testing process in a TTC appeared to be safe (low re-presentation and low mortality) and is feasible (low overruling of informal triage). A COVID-19 diagnosis based on clinical parameters only does not appear possible.

Keywords: COVID-19; SARS-CoV-2; Triage and Test Center; disposition; drive-thru testing; resource allocation; symptoms.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure A1
Figure A1
SARS-CoV-2 positive PCR during study period from 19th March to 29th April 2020 (gray marking); SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2; PCR = Polymerase Chain Reaction.
Figure A2
Figure A2
Odds for positive SARS-CoV-2-testing during study period; SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2.
Figure 1
Figure 1
Flowchart of inclusion. TTC = Triage and Test Center; PDSR = Physician Disease Severity Rating; ED = Emergency Department.
Figure 2
Figure 2
Re-presentations of discharged patients during 30-day follow-up; ED = Emergency Department; TTC = Triage and Test Center; PDSR = Physician Disease Severity Rating; ICU = Intensive Care Unit.
Figure 3
Figure 3
Forest plot for symptoms and comorbidities. COPD = Chronic Obstructive Pulmonary Disease.
See this image and copyright information in PMC

References

    1. Prather K.A., Wang C.C., Schooley R.T. Reducing transmission of SARS-CoV-2. Science. 2020;368:1422–1424. doi: 10.1126/science.abc6197. - DOI - PubMed
    1. Salathé M., Althaus C.L., Neher R., Stringhini S., Hodcroft E., Fellay J., Zwahlen M., Senti G., Battegay M., Wilder-Smith A., et al. COVID-19 epidemic in Switzerland: On the importance of testing, contact tracing and isolation. Swiss Med. Wkly. 2020;150:w20225. doi: 10.4414/smw.2020.20225. - DOI - PubMed
    1. Bingisser R., Baerlocher S.M., Kuster T., Ortega R.N., Nickel C.H. Physicians’ Disease Severity Ratings are Non-Inferior to the Emergency Severity Index. J. Clin. Med. 2020;9:762. doi: 10.3390/jcm9030762. - DOI - PMC - PubMed
    1. Nickel C.H., Kellett J., Ortega R.N., Lyngholm L., Hanson S., Cooksley T., Bingisser R., Brabrand M. A simple prognostic score predicts one-year mortality of alert and calm emergency department patients: A prospective two-center observational study. Int. J. Clin. Pr. 2020;74:e13481. doi: 10.1111/ijcp.13481. - DOI - PubMed
    1. Kellett J., Nickel C.H., Skyttberg N., Brabrand M. Is it possible to quickly identify acutely unwell patients who can be safely managed as outpatients? The need for a "Universal Safe to Discharge Score". Eur. J. Intern. Med. 2019;67:e13–e15. doi: 10.1016/j.ejim.2019.07.018. - DOI - PubMed

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