COVID-19 or not COVID-19, that is the question. The role of screening criteria and point-of-care lung ultrasound in the triage decision-making process in an Emergency Department during the phase 2 of the COVID-19 Italian epidemic

Poggiali, Erika; Bastoni, Davide; Ferrari, Mariachiara; Moretto, Dario; Buttafava, Federico; Ramos, Pau Mateo; Burzio, Valentina; Petri, Jolanda; Magnacavallo, Andrea; Vercelli, Andrea

doi:10.4081/ecj.2021.9708

Cited by 4 publications

(1 citation statement)

References 15 publications

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“…Based on these observations, we needed to develop a strategy to avoid the spread of the SARS-CoV-2 in the "clean areas" of the ED and as a reflection, of the hospital. During the "phase 2" of the COVID-19 Italian epidemic, we designed a pre-triage decision making-process, based on the pre-triage interview combined with LUS performed in the triage area, confirming the pivotal role of the triage to promptly identify COVID-19 patients even in absence of typical signs and symptoms of the infection [33]. Our study failed to demonstrate the utility of LUS because of the small size of the patient sample that we investigated in the study; we designed a new safety protocol to identify COVID-19 patients promptly after their arrival in the triage, and we created different pathways and areas in the ED to curb the risk of transmission as much as possible and, as a consequence, to avoid the development of outbreaks in the hospital.…”

Section: Introductionmentioning

confidence: 99%

From the Triage to the Intermediate Area: A Simple and Fast Model for COVID-19 in the Emergency Department

Poggiali

Fabrizi

Bastoni

et al. 2022

IJERPH

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Introduction: The early identification of patients with SARS-CoV-2 infection is still a real challenge for emergency departments (ED). First, we aimed to develop a score, based on the use of the lung ultrasonography (LUS), in addition to the pre-triage interview, to correctly address patients; second, we aimed to prove the usefulness of a three-path organization (COVID-19, not-COVID-19 and intermediate) compared to a two-path organization (COVID-19, non-COVID-19). Methods: We retrospectively analysed 292 patients admitted to our ED from 10 April to 15 April 2020, with a definite diagnosis of positivity (93 COVID-19 patients) or negativity (179 not-COVID-19 patients) for SARS-COV-2 infection. Using a logistic regression, we found a set of predictors for infection selected from the pre-triage interview items and the LUS findings, which contribute with a different weight to the final score. Then, we compared the organization of two different pathways. Results: The most informative factors for classifying the patient are known nasopharyngeal swab positivity, close contact with a COVID-19 patient, fever associated with respiratory symptoms, respiratory failure, anosmia or dysgeusia, and the ultrasound criteria of diffuse alveolar interstitial syndrome, absence of B-lines and presence of pleural effusion. Their sensitivity, specificity, accuracy, and AUC-ROC are, respectively, 0.83, 0.81, 0.82 and 0.81. The most significant difference between the two pathways is the percentage of not-COVID-19 patients assigned to the COVID-19 area, that is, 10.6% (19/179) in the three-path organization, and 18.9% (34/179) in the two-path organization (p = 0,037). Conclusions: Our study suggests the possibility to use a score based on the pre-triage interview and the LUS findings to correctly manage the patients admitted to the ED, and the importance of an intermediate area to limit the spread of SARS-CoV-2 in the ED and, as a consequence, in the hospital.

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Section: Introductionmentioning

confidence: 99%

From the Triage to the Intermediate Area: A Simple and Fast Model for COVID-19 in the Emergency Department

Poggiali

Fabrizi

Bastoni

et al. 2022

IJERPH

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SARS-CoV-2 management in Emergency Department: risk stratification and care setting identification proposal based on first pandemic wave in Pisa University Hospital

Barbieri

Cipriano²,

Carrara³

et al. 2021

Emer. Care J.

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SARS-CoV-2 management in Emergency Department: risk stratification and care setting identification proposal based on first pandemic wave in Pisa University Hospital Background: COVID-19 patients require early treatment and admission to an appropriate care setting, considering possible rapid and unpredictable to Severe Acute Respiratory Syndrome. Objective: A flow-chart was developed by a multidisciplinary team of Emergency Department (ED) clinicians, intensivists and radiologists aiming to provide tools for disease severity stratification, appropriate ventilation strategy and hospitalization setting identification. Methods: We conducted a retrospective application of our model on 313 hospitalized patients at Pisa University Hospital including 222 patients admitted to ED for respiratory failure between March and April 2020. Risk stratification score was based on respiratory and chest imaging parameters, while management strategy on comorbidities and age. Results: Age, comorbidities, clinical respiratory and arterial blood gas parameters, semi-quantitative chest computed tomography score were significant predictors of mortality (p<0,05). Mortality rate was higher in patients treated in intensive care units (26,5%) and undergoing endo-tracheal intubation (32,7%), compared to medical area (21,3%). We verified a good concordance (81,7%) between the proposed model and actual evaluation in ED. Outcomes analysis of subgroups of patients homogeneous for baseline features allowed to verify safety of our model: in non-elderly and/or non-comorbid patients (15% mortality) our scheme overestimates the risk in 30% of cases, but it suggests non-intensive management in patients with reduced functional reserve, elderly and with comorbidities (50% mortality). Conclusion: Correct management of respiratory failure COVID-19 patients is crucial in this unexpected pandemic. Our flow-chart, despite retrospectively application in small sample, could represents a valid and safe proposal for evaluation in ED.

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“If you want to change the world, pick up your pen and write”

Ghiadoni

2021

Emerg Care J

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COVID-19 or not COVID-19, that is the question. The role of screening criteria and point-of-care lung ultrasound in the triage decision-making process in an Emergency Department during the phase 2 of the COVID-19 Italian epidemic

Cited by 4 publications

References 15 publications

From the Triage to the Intermediate Area: A Simple and Fast Model for COVID-19 in the Emergency Department

From the Triage to the Intermediate Area: A Simple and Fast Model for COVID-19 in the Emergency Department

SARS-CoV-2 management in Emergency Department: risk stratification and care setting identification proposal based on first pandemic wave in Pisa University Hospital

“If you want to change the world, pick up your pen and write”

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