Triage tool for suspected COVID-19 patients in the emergency room: AIFELL score

Levenfus, Ian; Ullmann, Enrico; Battegay, Edouard; Schuurmans, Macé M.

doi:10.1016/j.bjid.2020.07.003

Cited by 19 publications

(26 citation statements)

References 14 publications

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“…The population understands some words, like "therapeutic obstinacy, " and in fact the idea is to use these words, but not everyone is really able to understand them." (Participant 4, age range [31][32][33][34][35][36][37][38][39][40] One participant added that the difficulty to address endof-life issues is also common among HCPs and not only family members: "Colleagues lack sensitivity on this. .…”

Section: Paternalism's Comebackmentioning

confidence: 99%

“…Think about how difficult this is to accept." (Participant 4, age range [31][32][33][34][35][36][37][38][39][40] Participants also reported that the absence of the family members, who could not be close to the patients in the hospital and frequently interact with the care team, accentuated this form of paternalism and prevented a shared decision making approach.…”

Section: Paternalism's Comebackmentioning

confidence: 99%

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Physicians' Acceptance of Triage Guidelines in the Context of the COVID-19 Pandemic: A Qualitative Study

Merlo

Lepori

Malacrida³

et al. 2021

Front. Public Health

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Aims: One of the major ethical challenges posed by the Covid-19 pandemic comes in the form of fair triage decisions for critically ill patients in situations where life-saving resources are limited. In Spring 2020, the Swiss Academy of Medical Sciences (SAMS) issued specific guidelines on triage for intensive-care treatment in the context of the Covid-19 pandemic. While evidence has shown that the capacities of intensive care medicine throughout Switzerland were sufficient to take care of all critically ill patients during the first wave of the outbreak, no evidence is available regarding the acceptance of these guidelines by ICU staff. The aim of this qualitative study was to explore the acceptance and perceived implementation of the SAMS guidelines among a sample of senior physicians involved in the care of Covid-19 patients in the Canton of Ticino. Specific objectives included capturing and describing physicians' attitudes toward the guidelines, any challenges experienced in their application, and any perceived factors that facilitated or would facilitate their application.Methods: We conducted face-to-face and telephone interviews with a purposive sample of nine senior physicians employed as either head of unity, deputy-head of unit, or medical director in either one of the two Covid-19 hospitals in the Canton of Ticino during the peak of the outbreak. Interviews were transcribed verbatim and thematically analyzed using an inductive approach.Results: We found that participants held different views regarding the nature of the guidelines, saw decisions on admission as a matter of collective responsibility, argued that decisions should be based on a medical futility principle rather than an age criterion, and found that difficulties to address end-of-life issues led to a comeback of paternalism.Conclusions: Results highlight the importance of clarifying the nature of the guidelines, establishing authority, and responsibility during triaging decisions, recognizing and addressing sources of interference with patients' autonomy, and the need of a cultural shift in timely and efficiently addressing end-of-life issues.

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Section: Paternalism's Comebackmentioning

confidence: 99%

Section: Paternalism's Comebackmentioning

confidence: 99%

Physicians' Acceptance of Triage Guidelines in the Context of the COVID-19 Pandemic: A Qualitative Study

Merlo

Lepori

Malacrida³

et al. 2021

Front. Public Health

View full text Add to dashboard Cite

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“…Severity of disease was classified according to Siddiqi [5]. The risk stratification by the AIFELL score was documented [6]. Data on antiviral, antibiotic and anti-inflammatory therapy were recorded, as well as clinical treatment setting (normal ward, intermediate care, and intensive care).…”

Section: Study Population Setting and Clinical Datamentioning

confidence: 99%

“…The AIFELL score, developed by Levenfus et al, is a clinical prediction score used for triage purposes to assess risk and provide guidance of further diagnostic and therapeutic steps in patients suspected to have COVID-19 [6]. It can be easily applied in emergency wards, and also has an interactive website (www.aifell.net) correlating the AIFELL score to the above-mentioned Siddiqi stages.…”

Section: Aifell Scorementioning

confidence: 99%

Clinical Characteristics, Treatments and Outcomes of 18 Lung Transplant Recipients with COVID-19

et al. 2021

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We report clinical features, treatments and outcomes in 18 lung transplant recipients with laboratory confirmed SARS-CoV-2 infection. We performed a single center, retrospective case series study of lung transplant recipients, who tested positive for SARS-CoV-2 between 1 February 2020 and 1 March 2021. Clinical, laboratory and radiology findingswere obtained. Treatment regimens and patient outcome data were obtained by reviewing the electronic medical record. Mean age was 49.9 (22–68) years, and twelve (67%) patients were male. The most common symptoms were fever (n = 9, 50%), nausea/vomiting (n = 7, 39%), cough (n = 6, 33%), dyspnea (n = 6, 33%) and fatigue (n = 6, 33%). Headache was reported by five patients (28%). The most notable laboratory findings were elevated levels of C-reactive protein (CRP) and lactate dehydrogenase (LDH). Computed Tomography (CT) of the chest was performed in all hospitalized patients (n = 11, 7%), and showed ground-glass opacities (GGO) in 11 patients (100%), of whom nine (82%) had GGO combined with pulmonary consolidations. Six (33%) patients received remdesivir, five (28%) intravenous dexamethasone either alone or in combination with remdesivir, and 15 (83%) were treated with broad spectrum antibiotics including co-amoxicillin, tazobactam-piperacillin and meropenem. Four (22%) patients were transferred to the intensive care unit, two patients (11%) required invasive mechanical ventilation who could not be successfully extubated and died. Eighty-nine percent of our patients survived COVID-19 and were cured. Two patients with severe COVID-19 did not survive.

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“…With the highly developed health-care system, technology, and communication infrastructures in Dubai, it was manageable to deal with the large flow of patients on daily basis. One way to overcome this challenge was (Triage Score) as done by the University Hospital in Zurich, who created a triage score to help the doctors at ER to decide if the patient needs hospital admission or could be discharged to home isolation which consists of clinical, radiological, and laboratory findings [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Telemedicine versus Physical Examination in Patients’ Assessment during COVID-19 Pandemic: The Dubai Experience

et al. 2021

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Introduction: With the large number of cases during the COVID-19 pandemic, a smart tool was urgently needed to handle all the positive cases at proper time such as using the technology and implementing telemedicine for triage. Objective: The purpose of this study is to detect the accuracy and effectiveness of telemedicine as an assessment tool for triage compared to physical assessment. Methods: In a random sample of 1,086 COVID-19 positive cases during the pandemic in Dubai, all the patients were initially assessed by trained staff using telemedicine following a standardized guidelines and accordingly action was taken by sending the patient to an isolation facility or for hospital admission; the second phase of assessment was conducted physically at the facility. We compared the accuracy of assessment by telemedicine encounter versus physical assessment by detecting any changes of the initial action within 12 h. Results: Telemedicine was accurate in 1,080 out of 1,086 screened patients (99.4%). Discussion: Telemedicine offers fast and convenient response to patients needs with standardization of triage guidelines. Telemedicine has reduced exposure of the medical workers which reduced the possibility of infection as well as reduction of crowds at the medical centers. Recommendations: Telemedicine is very useful during the COVID-19 pandemic for following up the positive and suspected cases as well as cases with history of close contact with a confirmed positive case.

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Triage tool for suspected COVID-19 patients in the emergency room: AIFELL score

Cited by 19 publications

References 14 publications

Physicians' Acceptance of Triage Guidelines in the Context of the COVID-19 Pandemic: A Qualitative Study

Physicians' Acceptance of Triage Guidelines in the Context of the COVID-19 Pandemic: A Qualitative Study

Clinical Characteristics, Treatments and Outcomes of 18 Lung Transplant Recipients with COVID-19

Telemedicine versus Physical Examination in Patients’ Assessment during COVID-19 Pandemic: The Dubai Experience

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