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Background Waiting for triage in overburdened emergency departments (ED) has become an increasing problem, which endangers patients. A fast triage system to rapidly identifying low acuity patients should divert care and resources to more urgent cases. Aim Objective of this study was to compare the performance of the Kitovu Hospital fast triage score (KFT) with the Emergency Severity Index (ESI), using mortality and hospital admission as proxies for the patients’ acuity. Design A prospective observational study of consecutive patients presenting to a Swiss academic ED. Methods Patients were prospectively triaged into one of five ESI strata, and retrospectively assessed by the KFT score, which awards 1 point each for altered mental status, impaired mobility, and oxygen saturation <94%. Results The KFT score had a lower discrimination than the ESI for hospital admission, but a higher discrimination for mortality from 24-hour to one year after ED presentation. 5544 (67%) patients were assigned to the lowest acuity by the KFT score compared with 2,374 (28·7%) by the ESI; there was no significant difference in the 24-hour mortality of patients who were deemed low acuity by either score. Conclusion Compared to the ESI, the KFT score identifies more than twice as many patients at low risk of early death. Therefore, this score might help to identify patients who could be managed through alternative pathways. This may be particularly helpful in situations of ED crowding and access block.

Background Early identification of SARS-CoV-2 infection is important to guide quarantine and reduce transmission. This study evaluates the diagnostic performance of lung ultrasound (LUS), an affordable, consumable-free point-of-care tool, for COVID-19 screening. Methods This prospective observational cohort included adults presenting with cough and/or dyspnea at a SARS-CoV-2 screening center of Lausanne University Hospital between March 31st and May 8th, 2020. Investigators recorded standardized LUS images and videos in 10 lung zones per subject. Two blinded independent experts reviewed LUS recording and classified abnormal findings according to pre-specified criteria to investigate their predictive value to diagnose SARS-CoV-2 infection according to PCR on nasopharyngeal swabs (COVIDpos vs COVIDneg). We finally combined LUS and clinical findings to derive a multivariate logistic regression diagnostic score. Results Of 134 included patients, 23% (n=30/134) were COVIDpos and 77% (n=103/134) were COVIDneg; 85%, (n=114/134) cases were previously healthy healthcare workers presenting within 2 to 5 days of symptom onset (IQR). Abnormal LUS findings were significantly more frequent in COVIDpos compared to COVIDneg (45% versus 26%, p=0.045) and mostly consisted of focal pathologic B-lines. Combining LUS findings in a multivariate logistic regression score had an area under the receiver-operating curve of 63.9% to detect COVID-19, but improved to 84.5% with the addition of clinical features. Conclusions COVIDpos patients are significantly more likely to have lung pathology by LUS. Our findings have potential diagnostic value for COVID-19 at the point of care. Combination of clinical and LUS features showed promising results, which need confirmation in a larger study population.

Purpose: The Clinical Frailty Scale (CFS) allows health care providers to quickly stratify older patients, in order to support clinical decision making. However, few studies have evaluated the CFS interrater reliability (IRR) in Emergency Departments (EDs), and the freely available smartphone application for CFS assessment was never tested for reliability. This study aimed to evaluate the IRR of CFS ratings comparing assessments by ED clinicians and a study team supported by a smartphone application for CFS assessment, and to determine the proportion of patients aged 65 or older who were assigned a CFS level in our ED in routine clinical care.Methods: Prospective study using consecutive sampling of ED patients aged 65 or older. We compared assessments by ED clinicians (Triage Clinicians (TC) and geriatric ED trained nurses (geriED-TN)) and a study team (ST) using a smartphone application for CFS scoring. The study is registered on Clinicaltrials.gov (NCT05400707).Results: We included 1,348 patients aged 65 and older. Quadratic-weighted kappa values for ordinal CFS levels showed a good IRR between TC and ST (ϰ=0.73, 95% CI: 0.69–0.76), similarly to that between TC and geriED-TN (ϰ=0.75, 95% CI: 0.66–0.82) and between the ST and geriED-TN (ϰ=0.74, 95% CI: 0.63–0.81). A CFS rating was assigned to 972 (70.2%) patients at triage.Conclusion: We found good IRR in the assessment of frailty with the CFS in different ED providers and a team of medical students using a smartphone application to support rating. A CFS assessment occurred in more than two thirds (70.2%) of patients at triage.

ObjectivesEarly identification of SARS-CoV-2 infection is important to guide quarantine and reduce transmission. This study evaluates the diagnostic performance of lung ultrasound (LUS), an affordable, consumable-free point-of-care tool, for COVID-19 screening.Design, setting and participantsThis prospective observational cohort included adults presenting with cough and/or dyspnoea at a SARS-CoV-2 screening centre of Lausanne University Hospital between 31 March and 8 May 2020.InterventionsInvestigators recorded standardised LUS images and videos in 10 lung zones per patient. Two blinded independent experts reviewed LUS recording and classified abnormal findings according to prespecified criteria to investigate their predictive value to diagnose SARS-CoV-2 infection according to PCR on nasopharyngeal swabs (COVID-19 positive vs COVID-19 negative).Primary and secondary outcome measuresWe finally combined LUS and clinical findings to derive a multivariate logistic regression diagnostic score.ResultsOf 134 included patients, 23% (n=30/134) were COVID-19 positive and 77% (n=103/134) were COVID-19 negative; 85%, (n=114/134) cases were previously healthy healthcare workers presenting within 2–5 days of symptom onset (IQR). Abnormal LUS findings were significantly more frequent in COVID-19 positive compared with COVID-19 negative (45% vs 26%, p=0.045) and mostly consisted of focal pathologic B lines. Combining clinical findings in a multivariate logistic regression score had an area under the receiver operating curve of 80.3% to detect COVID-19, and slightly improved to 84.5% with the addition of LUS features.ConclusionsCOVID-19-positive patients are significantly more likely to have lung pathology by LUS. However, LUS has an insufficient sensitivity and is not an appropriate screening tool in outpatients. LUS only adds little value to clinical features alone.