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. 2022 Apr:54:274-278.
doi: 10.1016/j.ajem.2022.01.070. Epub 2022 Feb 6.

Should COVID-19 symptoms be used to cohort patients in the emergency department? A retrospective analysis

Polly E Bijur  1 , Benjamin W Friedman  2 , Sarah W Baron  3 , Abhiram Ramasahayam  4 , Rebecca Nerenberg  5 , Shellyann Sharpe  6 , D Yitzchak Goldstein  7 , David Esses  8
Affiliations

Should COVID-19 symptoms be used to cohort patients in the emergency department? A retrospective analysis

Polly E Bijur et al. Am J Emerg Med. 2022 Apr.

Abstract

Objective: To determine how cohorting patients based on presenting complaints affects risk of nosocomial infection in crowded Emergency Departments (EDs) under conditions of high and low prevalence of COVID-19.

Methods: This was a retrospective analysis of presenting complaints and PCR tests collected during the COVID-19 epidemic from 4 EDs from a large hospital system in Bronx County, NY, from May 1, 2020 to April 30, 2021. Sensitivity, specificity, positive and negative predictive value (PPV, NPV) were calculated for a symptom screen based on the CDC list of COVID-19 symptoms: fever/chills, shortness of breath/dyspnea, cough, muscle or body ache, fatigue, headache, loss of taste or smell, sore throat, nasal congestion/runny nose, nausea, vomiting, and diarrhea. PPV was calculated for varying values of prevalence.

Results: There were 80,078 visits with PCR tests. The sensitivity of the symptom screen was 64.7% (95% CI: 63.6, 65.8), specificity 65.4% (65.1, 65.8). PPV was 16.8% (16.5, 17.0) and NPV was 94.5% (94.4, 94.7) when the observed prevalence of COVID-19 in the ED over the year was 9.7%. The PPV of fever/chills, cough, body and muscle aches and nasal congestion/runny nose were each approximately 25% across the year, while diarrhea, nausea, vomiting and headache were less predictive, (PPV 4.7%-9.6%) The combinations of fever/chills, cough, muscle/body aches, and shortness of breath had PPVs of 40-50%. The PPV of the screen varied from 3.7% (3.6, 3.8) at 2% prevalence of COVID-19 to 44.3% (44.0, 44.7) at 30% prevalence.

Conclusion: The proportion of patients with a chief complaint of COVID-19 symptoms and confirmed COVID-19 infection was exceeded by the proportion without actual infection. This was true when prevalence in the ED was as high as 30%. Cohorting of patients based on the CDC's list of COVID-19 symptoms will expose many patients who do not have COVID-19 to risk of nosocomially acquired COVID-19. EDs should not use the CDC list of COVID-19 symptoms as the only strategy to minimize exposure.

Keywords: COVID-19 testing; Emergency service, hospital; Predictive value of tests; Sensitivity and specificity.

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Conflict of interest statement

Declaration of Competing Interest There are no competing interests.

Figures

Fig. 1
Fig. 1
Percent COVID-19 positive by month, May 1, 2020 to April 30, 2021 and Group: patients with positive symptom screens; patients with negative symptom screens; all patients in Emergency Department with COVID-19 PCR tests; persons who received Bronx County COVID-19 antigen tests.
See this image and copyright information in PMC

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