Diagnostic algorithm for COVID-19 at the ER
OBJECTIVE: Evaluation of a diagnostic algorithm for estimating the risk of COVID-19 in patients who are referred to an emergency department for being suspected of having the disease.
DESIGN: Retrospective study.
METHOD: Patients with fever with no apparent cause and patients with recently developed respiratory symptoms, whether or not in combination with fever, were routinely given a PCR test, blood tests (lymphocyte count and LDH levels) and a chest CT scan. The CT scan was assessed according to the CO-RADS classification. Based on the findings, the patients were divided into 3 cohorts (proven COVID-19, strong suspicion of COVID-19, and low suspicion of COVID-19) and the appropriate isolation measures were taken.
RESULTS: In the period from 8 to 31 March 2020, the algorithm was applied to 312 patients. COVID-19 was proven for 69 (22%) patients. COVID-19 was strongly suspected for 151 (48%) patients and suspicion was low for the remaining 92 (29%) patients. The percentage of patients with positive PCR results and the percentage of patients with abnormal laboratory test results increased as the CO-RADS score increased. Among patients with a CO-RADS score of 4 or 5, this percentage increased further when they also had lymphopenia or elevated LDH levels. We have adjusted the flowchart based on our findings.
CONCLUSION: In case of patients who have been referred to an emergency department for suspected COVID-19, a good COVID-19 risk assessment can be made on the basis of clinical signs, laboratory abnormalities and low-dose CT scans. Even before the results of the PCR test are known and even if the results are negative, patients can be classified as 'proven COVID-19 patients' using the algorithm.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:164 |
|---|---|
| Enthalten in: |
Nederlands tijdschrift voor geneeskunde - 164(2020) vom: 14. Mai |
| Sprache: |
Niederländisch |
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| Weiterer Titel: |
Diagnostisch algoritme voor COVID-19 op de SEH |
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| Beteiligte Personen: |
Dofferhoff, A S M [VerfasserIn] |
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| Themen: |
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| Anmerkungen: |
Date Completed 20.05.2020 Date Revised 18.12.2020 published: Electronic Citation Status MEDLINE |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM309894905 |
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| 246 | 3 | 3 | |a Diagnostisch algoritme voor COVID-19 op de SEH |
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| 500 | |a Date Completed 20.05.2020 | ||
| 500 | |a Date Revised 18.12.2020 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a OBJECTIVE: Evaluation of a diagnostic algorithm for estimating the risk of COVID-19 in patients who are referred to an emergency department for being suspected of having the disease | ||
| 520 | |a DESIGN: Retrospective study | ||
| 520 | |a METHOD: Patients with fever with no apparent cause and patients with recently developed respiratory symptoms, whether or not in combination with fever, were routinely given a PCR test, blood tests (lymphocyte count and LDH levels) and a chest CT scan. The CT scan was assessed according to the CO-RADS classification. Based on the findings, the patients were divided into 3 cohorts (proven COVID-19, strong suspicion of COVID-19, and low suspicion of COVID-19) and the appropriate isolation measures were taken | ||
| 520 | |a RESULTS: In the period from 8 to 31 March 2020, the algorithm was applied to 312 patients. COVID-19 was proven for 69 (22%) patients. COVID-19 was strongly suspected for 151 (48%) patients and suspicion was low for the remaining 92 (29%) patients. The percentage of patients with positive PCR results and the percentage of patients with abnormal laboratory test results increased as the CO-RADS score increased. Among patients with a CO-RADS score of 4 or 5, this percentage increased further when they also had lymphopenia or elevated LDH levels. We have adjusted the flowchart based on our findings | ||
| 520 | |a CONCLUSION: In case of patients who have been referred to an emergency department for suspected COVID-19, a good COVID-19 risk assessment can be made on the basis of clinical signs, laboratory abnormalities and low-dose CT scans. Even before the results of the PCR test are known and even if the results are negative, patients can be classified as 'proven COVID-19 patients' using the algorithm | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Swinkels, A |e verfasserin |4 aut | |
| 700 | 1 | |a Sprong, T |e verfasserin |4 aut | |
| 700 | 1 | |a Berk, Y |e verfasserin |4 aut | |
| 700 | 1 | |a Spanbroek, M |e verfasserin |4 aut | |
| 700 | 1 | |a Nabuurs-Franssen, M H |e verfasserin |4 aut | |
| 700 | 1 | |a Vermaat, M |e verfasserin |4 aut | |
| 700 | 1 | |a van de Kerkhof, B |e verfasserin |4 aut | |
| 700 | 1 | |a Willekens, M H C |e verfasserin |4 aut | |
| 700 | 1 | |a Voss, A |e verfasserin |4 aut | |
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