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. 2021 Apr 5;22(3):587-591.
doi: 10.5811/westjem.2020.12.49470.

Utility Of An Emergency Department Clinical Protocol For Early Identification of Coronavirus Infection

William Bonadio  1 , Kaedrea Jackson  1 , Lindsey Gottlieb  1 , Eric Legome  1
Affiliations

Utility Of An Emergency Department Clinical Protocol For Early Identification of Coronavirus Infection

William Bonadio et al. West J Emerg Med. .

Abstract

Introduction: We assessed the utility of an emergency department (ED) protocol using clinical parameters to rapidly distinguish likelihood of novel coronavirus 2019 (COVID-19) infection; the applicability aimed to stratify infectious-risk pre-polymerase chain reaction (PCR) test results and accurately guide early patient cohorting decisions.

Methods: We performed this prospective study over a two-month period during the initial surge of the 2020 COVID-19 pandemic in a busy urban ED of patients presenting with respiratory symptoms who were admitted for in-patient care. Per protocol, each patient received assessment consisting of five clinical parameters: presence of fever; hypoxia; cough; shortness of breath/dyspnea; and performance of a chest radiograph to assess for bilateral pulmonary infiltrates. All patients received nasopharyngeal COVID-19 PCR testing.

Results: Of 283 patients studied, 221 (78%) were PCR+ and 62 (22%) PCR-. Chest radiograph revealed bilateral pulmonary infiltrates in 85%, which was significantly more common in PCR+ (94%) vs PCR- (52%) patients (P < 0.0001). The rate of manifesting all five positive clinical parameters was significantly greater in PCR+ (63%) vs PCR- (6.5%) patients (P < 0.0001). For PCR+ outcome, the presence of all five positive clinical parameters had a specificity of 94%, positive predictive value of 98%, and positive likelihood ratio of 10.

Conclusions: Using an ED protocol to rapidly assess five clinical parameters accurately distinguishes likelihood of COVID-19 infection prior to PCR test results, and can be used to augment early patient cohorting decisions.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

References

    1. Rothfield M, Sengupta S, Goldstein J, et al. 13 deaths in a day: an apocalyptic coronavirus surge at a N.Y.C. hospital. 2020. [Accessed: March 25, 2020]. Available at: https://www.nytimes.com/2020/03/25/nyregion/nyc-coronavirus-hospitals.html.
    1. Fanella S, Pinto M, Bridger N, et al. Pandemic (H1N1) 2009 influenza in hospitalized children in Manitoba: nosocomial transmission and lessons learned from the first wave. Infect Cont Hosp Ep. 2011;32:435–43. - PubMed
    1. Youngs J, Marshall B, Farragher M, et al. Implementation of influenza point-of-care testing and patient cohorting during a high-incidence season: a retrospective analysus of impact on infection prevention and control and clinical outcomes. J Hosp Infect. 2019;101:276–84. - PubMed
    1. Altman D, Machin D, Bryant T, et al. Proportion and their differences. In: Altman D, Machin D, Bryant T, Gardner M, editors. Statistics with Confidence: Confidence Intervals and Statistical Guidelines. 2nd Edition. United Kingdom: BMJ Books; 2000. pp. 45–56.
    1. Mercaldo N, Lau K, Zhou X. Confidence intervals for predictive values with an emphasis to case-control studies. Stat Med. 2007;26:2170–21. - PubMed