Prehospital characteristics of COVID-19 patients in Helsinki – experience of the first wave of the pandemic

Abstract

Background There is a lack of knowledge how patients with COVID-19 disease differ from patients with similar signs or symptoms (but who will have a diagnosis other than COVID-19) in the prehospital setting. The aim of this study was to compare the characteristics of these two patient groups met by the emergency medical services. Methods All prehospital patients after the World Health Organisation (WHO) pandemic declaration 11.3.2020 until 30.6.2020 were recruited for the study. The patients were screened using modified WHO criteria for suspected COVID-19. Data from the electronic prehospital patient reporting system were linked with hospital laboratory results to check the laboratory confirmation for COVID-19. For comparison, we divided the patients into two groups: screening- and laboratory-positive patients with a hospital diagnosis of COVID-19 and screening-positive but laboratory-negative patients who eventually received a different diagnosis in hospital. Results A total of 4157 prehospital patients fulfilled the criteria for suspected COVID-19 infection during the study period. Five-hundred-thirty-six (12.9%) of the suspected cases received a laboratory confirmation for COVID-19. The proportion of positive cases in relation to suspected ones peaked during the first 2 weeks after the declaration of the pandemic. In the comparison of laboratory-positive and laboratory-negative cases, there were clinically insignificant differences between the groups in age, tympanic temperature, systolic blood pressure, heart rate, on-scene time, urgency category of the call and mode of transportation. Foreign-language-speakers were overrepresented amongst the positive cases over native language speakers (26,6% vs. 7,4%, p < 0,001). The number of cases in which no signs or symptoms of COVID-19 disease were reported, but patients turned out to have a positive test result was 125 (0,3% of the whole EMS patient population and 11,9% of all verified COVID-19 patients encountered by the EMS). Conclusions In a sample of suspected COVID-19 patients, the laboratory-positive and laboratory-negative patients were clinically indistinguishable from each other during the prehospital assessment. Foreign-language-speakers had a high likelihood of having Covid-19. The modified WHO criteria still form the basis of screening of suspected COVID-19 patients in the prehospital setting.

Association between first language and SARS-CoV-2 infection rates, hospitalization, intensive care admissions and death in Finland: a population-based observational cohort study

“…Yet, testing was likely affected by practical problems such as poor domestic language skills or by lower test-seeking behaviour, or healthcare workers might have been more prone to direct persons speaking domestic languages to testing. Foreign language speakers were overrepresented in a previous study on prehospital COVID-19 patients in Helsinki, which may indicate delayed seeking of health care [ 10 ].…”

Influence of coronavirus disease 2019 case surges on prehospital emergency medical service for patients with trauma in Kobe, Japan

“…We used difficulty securing hospital acceptance as the dependent variable and duration of the states of emergency as the independent variable, adjusting for body temperature (>37.4°C), oxygen saturation without oxygen therapy at the trauma scene (<95%), age (>64 years), and systolic blood pressure (<90 mmHg), which might have influenced the difficulty securing hospital acceptance during the pandemic. 9,10 The time spent on the trauma scene during the states of emergency was stratified by trauma severity (less severe, moderately severe, severe, and life-threatening) and compared with that in the prepandemic period in 2019, respectively.…”

“…Logistic regression was performed using the incidence of difficulty securing hospital acceptance as the dependent variable. We used difficulty securing hospital acceptance as the dependent variable and duration of the states of emergency as the independent variable, adjusting for body temperature (>37.4°C), oxygen saturation without oxygen therapy at the trauma scene (<95%), age (>64 years), and systolic blood pressure (<90 mmHg), which might have influenced the difficulty securing hospital acceptance during the pandemic 9,10 …”

Sensitivity and specificity analyses of COVID-19 screening protocol for emergency medical services: A STARD-compliant population-based retrospective study

“…Our study results showed that the addition of clinical signs such as body temperature ≥37.5 °C, respiratory rate ≥20 breaths/minute, and SpO 2 < 90% can improve the sensitivity of the screening protocol. Although these signs are also nonspecific, [ 11 , 13 , 14 ] positive COVID-19 cases are likely to present with tachycardia, tachypnea, and/or low SpO 2 . [ 9 ] By adding 2 or more of these additional variables, the sensitivity of the screening protocol increased, while the specificity and PPV decreased.…”