Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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.

PubMed Disclaimer

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

References

    1. Bonadio W., Jackson K., Gottlieb L., Legome E. Utility of an emergency department clinical protocol for early identification of coronavirus infection. West J Emerg Med. 2021;22:587–591. doi: 10.5811/westjem.2020.12.49470. - DOI - PMC - PubMed
    1. Chu D.K., Akl E.A., Duda S., Solo K., Yaacoub S., Schünemann H.J., et al. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet. 2020;395:1973–1987. doi: 10.1016/S0140-6736(20)31142-9. - DOI - PMC - PubMed
    1. Hoot N.R., Aronsky D.J. Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med. 2008;52:126–136. doi: 10.1016/j.annemergmed.2008.03.014. - DOI - PMC - PubMed
    1. Centers for Disease Control Guideline for isolation precautions: Preventing transmission of infectious agents in healthcare settings. 2007. https://www.cdc.gov/infectioncontrol/guidelines/isolation/prevention.html [accessed 11 November 2021] - PMC - PubMed
    1. Centers for Disease Control Symptoms of COVID-19. 2021. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html [accessed 1 November 2021]