ORIGINAL ARTICLE   Open access

Italian Journal of Emergency Medicine 2020 August;9(2):106-11

DOI: 10.23736/S2532-1285.20.00032-4

Copyright © 2020 THE AUTHORS

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language: English

Dealing with patients with suspected COVID-19 active infection: a challenge for emergency physicians

Francesco BELLA, Chiara PES, Laura SINI, Costantino COSSU, Aurora VECCHIATO, Alessandra MELIS, Paolo PINNA PARPAGLIA ✉

Unit of Intermediate Care and Emergency Medicine, Sassari University Hospital, Sassari, Italy

BACKGROUND: Emergency departments (ED) have been hugely involved by COVID-19 outbreak and are still engaged with it. ED physicians need to establish easiest and reliable tools to speed-up active COVID-19 infection probability detection.
METHODS: Retrospective study carried out during COVID-19 outbreak on patients admitted at our ED and suspected for active infection according to triage evaluation algorithm. Covid-likely patients underwent an in-deep diagnostic work-up and nasopharyngeal swab (NFS) for COVID-19 confirmation or exclusion. According to NFS result, two cohorts were identified, namely COVID-19 confirmed, and COVID-19 not confirmed. Distribution of some epidemiological and clinical variable and computed tomography (CT) scan results were analyzed and compared. Patients not suspected for Covid-infection (Covid unlikely) who yet underwent NFS were considered for triage algorithm validation.
RESULTS: From 9 March to 26 April 2020, 290 patients (females: 44%, males: 56%), had been stratified as Covid likely. Sixty-two of them (21.4%) had active SARS-CoV-2 infection, whereas 228 (78.6%) had not. The stronger predictive factors of Covid active infection were contact with known Covid patient, provenience from nursing homes, fever and respiratory failure. On the other hand, normal CT scan demonstrated a very strong negative predictive value for SARS-CoV-2 infection (negative predictive value =99%), indeed none COVID-19 confirmed patient had normal CT scan.
CONCLUSIONS: Strong epidemiological information and only part of the well-known clinical and hematological signs of COVID-19 demonstrated to be trustworthy for predicting probability of active SARS-CoV-2 infection. On the other hand, high resolution CT scan of the chest exhibited a high negative predictive value and, at least in our experience, demonstrated to be an extremely efficient rule-out test in Covid likely patients.

KEY WORDS: Coronavirus; Emergency medicine; Polymerase chain reaction