COVID-19 Triage and Test Center: Safety, Feasibility, and Outcomes of Low-Threshold Testing

Abstract

This prospective observational study evaluated the safety and feasibility of a low threshold testing process in a Triage and Test Center (TTC) during the early course of the coronavirus disease 19 (COVID-19) pandemic. In addition, we aimed to identify clinical predictors for a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) swab result. Patients underwent informal triage, standardized history taking, and physician evaluation, only where indicated. Patients were observed for 30 days. Safety was the primary outcome and was defined as a COVID-19-related 30 day re-presentation rate <5% and mortality rate <1% in patients presenting to the TTC. Feasibility was defined as an overruling of informal triage <5%. Among 4815 presentations, 572 (11.9%) were tested positive for SARS-CoV-2, and 4774 were discharged. Mortality at 30-days was 0.04% (2 patients, one of which related to COVID-19). Fever (OR 2.03 [95% CI 1.70;2.42]), myalgia (OR 1.94 [1.63;2.31]), chills (OR 1.77 [1.44;2.16]), headache (OR 1.61 [1.34;1.94]), cough (OR 1.50 [1.24;1.83]), weakness (OR 1.46 [1.21;1.76]), and confusion (OR 1.39 [1.06;1.80]) were associated with test positivity. Re-presentation rate was 8% overall and 1.4% in COVID-19 related re-presentation (69 of 4774). The overruling rate of informal triage was 1.5%. According to our study, a low-threshold testing process in a TTC appeared to be safe (low re-presentation and low mortality) and is feasible (low overruling of informal triage). A COVID-19 diagnosis based on clinical parameters only does not appear possible.

Systematic screening on admission for SARS-CoV-2 to detect asymptomatic infections

“…The classification criteria were the same as for the clinical consideration of COVID-19 and consistently applied during the screening period: acute pulmonary symptoms and/or fever ≥ 38.0 °C and/or sudden onset of anosmia or ageusia, and/or acute confusion or deterioration in the elderly, unless otherwise explained. The number of positive tested patients in the Canton Basel-Stadt, the main catchment area of the University Hospital Basel, was surveyed by and retrieved from the cantonal authorities [ 10 ] with most SARS-CoV-2 tests deriving from the triage- and test center of the University Hospital Basel [ 11 ]. Categorical variables were summarized as counts and proportions and continuous variables as medians and interquartile ranges.…”

Association of Frailty with Adverse Outcomes in Patients with Suspected COVID-19 Infection

“…The new information provided by this cohort-study is the direct comparison between older COVID-19 positive and negative patients with comparable presenting symptoms and disease severity in a highly standardized setting [22]. Our main interest was the predictive power of frailty status, particularly when adjusted for age, in all patients presenting with suspected COVID-19.…”

“…SARS-CoV-2 infection was suspected in any patient with breathlessness, other respiratory symptoms or flu-like symptoms, such as fever, chills, sore throat, cough, myalgia, and headache [22]. In addition, patients with acute confusion or general deterioration (i.e., weakness and abnormal fatigue) were considered, if these symptoms could not be explained otherwise.…”

“…In the beginning of the first wave of the pandemic, we established a Triage and Test Centre (TTC) in a nearby church (30-m walking distance to the ED) where all patients with suspected COVID-19 were tested for the presence of SARS-CoV-2. Patients with a National Early Warning Score (NEWS) > 2, oxygen saturation < 94%, or a higher disease severity rating by physicians were directly referred to the ED [22,23].…”

“…All patients underwent cross-validated nasopharyngeal SARS-CoV-2 polymerase chain reaction (PCR) swab tests [22,24,25]. Patients were considered COVID-19 positive if one or multiple SARS-CoV-2 PCR swab tests (between 14 days prior to or post ED presentation) were positive.…”