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 May 27;158(10):466-471.
doi: 10.1016/j.medcle.2021.05.021. Epub 2022 Jun 9.

Radiography-based triage for COVID-19 in the Emergency Department in a Spanish cohort of patients

Abiu Sempere-González  1 , Jordi Llaneras-Artigues  1 , Iago Pinal-Fernández  2   3   4 , Esperanza Cañas-Ruano  1 , Olimpia Orozco-Gálvez  1 , Eva Domingo-Baldrich  1 , Xabier Michelena  1 , Beatriz Meza  1 , Eloi García-Vives  1 , Albert Gil-Vila  1 , Javier Sarrapio-Lorenzo  1 , Sheila Romero-Ruperto  1 , Francesc Sanpedro-Jiménez  1 , María Arranz-Betegón  1 , Andreu Fernández-Codina  1   5
Affiliations

Radiography-based triage for COVID-19 in the Emergency Department in a Spanish cohort of patients

Abiu Sempere-González et al. Med Clin (Engl Ed). .

Abstract
in English, Spanish

Background: Strategies to determine who could be safely discharged home from the Emergency Department (ED) in COVID-19 are needed to decongestion healthcare systems.

Objectives: To describe the outcomes of an ED triage system for non-severe patients with suspected COVID-19 and possible pneumonia based on chest X-ray (CXR) upon admission.

Material and methods: Retrospective, single-center study performed in Barcelona (Spain) during the COVID-19 peak in March-April 2020. Patients with COVID-19 symptoms and potential pneumonia, without respiratory insufficiency, with priority class IV-V (Andorran triage model) had a CXR upon admission. This approach tried to optimize resource use and to facilitate discharges. The results after adopting this organizational approach are reported.

Results: We included 834 patients, 53% were female. Most patients were white (66%) or Hispanic (27%). CXR showed pneumonia in 523 (62.7%). Compared to those without pneumonia, patients with pneumonia were older (55 vs 46.6 years old) and had a higher Charlson comorbidity index (1.9 vs 1.3). Patients with pneumonia were at a higher risk for a combined outcome of admission and/or death (91 vs 12%). Death rates tended to be numerically higher in the pneumonia group (10 vs 1). Among patients without pneumonia in the initial CXR, 10% reconsulted (40% of them with new pneumonia).

Conclusion: CXR identified pneumonia in a significant number of patients. Those without pneumonia were mostly discharged. Mortality among patients with an initially negative CXR was low. CXR triage for pneumonia in non-severe COVID-19 patients in the ED can be an effective strategy to optimize resource use.

Introducción: La pandemia de COVID-19 conlleva una alta ocupación de los servicios de urgencias (SU). Se requieren nuevas estrategias para optimizar la gestión de estos recursos.

Objetivos: Describir los resultados de un sistema de triaje en urgencias para pacientes no graves con sospecha de COVID-19 y posible neumonía, basado en la radiografía de tórax (RT).

Material y métodos: Estudio retrospectivo, unicéntrico realizado en Barcelona (España) entre marzo y abril de 2020. Se realizó una RT al ingreso en SU de pacientes con síntomas de COVID-19 y sospecha de neumonía, sin insuficiencia respiratoria, con una prioridad clase IV-V (sistema andorrano de triaje). Esta medida pretende optimizar los recursos y facilitar las altas. Se reportan los resultados tras adoptar esta estrategia.

Resultados: Se incluyeron 834 pacientes (53% mujeres, 66% caucásicos, 27% hispánicos). La RT mostró neumonía en 523 (62,7%). Comparados con los pacientes sin neumonía, los que sí la padecían eran mayores (55 vs. 46,6 años), con un índice de comorbilidad de Charlson más elevado (1,9 vs. 1,3) y con mayor riesgo de ingreso y/o muerte (91 vs. 12%). La mortalidad fue numéricamente mayor en el grupo con neumonía (10 vs. 1). El 10% de los pacientes sin neumonía en RT consultaron de nuevo al SU (40% con neumonía).

Conclusión: La RT identificó neumonía en múltiples pacientes. Los que no tenían neumonía fueron mayoritariamente dados de alta. La mortalidad entre pacientes con RT negativa fue baja. La RT como triaje para neumonía en pacientes con COVID-19 no grave puede ahorrar recursos.

Keywords: COVID-19; Emergency; Pneumonia; Radiography; Triage.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Flow chart for suspected COVID-19 triage at the ED. ED = Emergency Department, MAT = Model Andorrà de Triatge (Andorran triage model), PCR = polymerase chain reaction. All quantitative variables are shown as median (standard deviation).
See this image and copyright information in PMC

Comment in

  • Response to "Radiography-based triage for COVID-19 in the Emergency Department in a Spanish cohort of patients".
    Gil-Rodrigo A, Luque-Hernández MJ, Gutiérrez-García C. Gil-Rodrigo A, et al. Med Clin (Barc). 2023 Feb 10;160(3):139-140. doi: 10.1016/j.medcli.2022.09.012. Epub 2022 Oct 24. Med Clin (Barc). 2023. PMID: 36396479 Free PMC article. No abstract available.
  • Reply.
    Fernández-Codina A, Sempere-González A, Cañas-Ruano E; Vall d’Hebron University Hospital COVID 19 ED research group. Fernández-Codina A, et al. Med Clin (Barc). 2023 Feb 10;160(3):140-141. doi: 10.1016/j.medcli.2022.10.006. Epub 2022 Oct 24. Med Clin (Barc). 2023. PMID: 36424191 Free PMC article. No abstract available.

Similar articles

See all similar articles

References

    1. Weekly epidemiological update – 24 November 2020; n.d.
    1. Pericàs J.M., Hernandez-Meneses M., Sheahan T.P., Quintana E., Ambrosioni J., Sandoval E., et al. COVID-19: from epidemiology to treatment. Eur Heart J. 2020;41:2092–2112. - PMC - PubMed
    1. Goyal P., Choi J.J., Pinheiro L.C., Schenck E.J., Chen R., Jabri A., et al. Clinical characteristics of COVID-19 in New York City. N Engl J Med. 2020;382:2372–2374. - PMC - PubMed
    1. Huang C., Wang Y., Li X., Ren L., Zhao J., Hu Y., et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497–506. - PMC - PubMed
    1. Yang X., Yu Y., Xu J., Shu H., Xia J., Liu H., et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8:475–481. - PMC - PubMed

LinkOut - more resources