Usefulness of PCR Screening in the Initial Triage of Trauma Patients During COVID-19 Pandemic

Abstract

Background: Hospitals worldwide have postponed all nonessential surgery during the COVID-19 pandemic, but non-COVID-19 patients are still in urgent need of care. Uncertainty about a patient's COVID-19 status risks infecting health care workers and non-COVID-19 inpatients. We evaluated the use of quantitative reverse transcription polymerase chain reaction (RT-qPCR) screening for COVID-19 on admission for all patients with fractures. Methods: We conducted a retrospective cohort study of patients older than 18 years admitted with low-energy fractures who were tested by RT-qPCR for SARS-CoV-2 at any time during hospitalization. Two periods based on the applied testing protocol were defined. During the first period, patients were only tested because of epidemiological criteria or clinical suspicion based on fever, respiratory symptoms, or radiological findings. In the second period, all patients admitted for fracture treatment were screened by RT-qPCR. Results: We identified 15 patients in the first period and 42 in the second. In total, 9 (15.8%) patients without clinical or radiological findings tested positive at any moment. Five (33.3%) patients tested positive postoperatively in the first period and 3 (7.1%) in the second period ( P = 0.02). For clinically unsuspected patients, postoperative positive detection went from 3 of 15 (20%) during the first period to 2 of 42 (4.8%) in the second ( P = 0.11). Clinical symptoms demonstrated high specificity (92.1%) but poor sensitivity (52.6%) for infection detection. Conclusions: Symptom-based screening for COVID-19 has shown to be specific but not sensitive. Negative clinical symptoms do not rule out infection. Protocols and separated areas are necessary to treat infected patients. RT-qPCR testing on admission helps minimize the risk of nosocomial and occupational infection. Level of Evidence: Level IV, retrospective cohort study. See Instructions for Authors for a complete description of levels of evidence.

Trauma Care During the COVID-19 Pandemic: A Canadian Survey

“…Knowing that 56% of COVID-19 patient present with no or only mild symptoms [23], this strategy may need to be re-evaluated. A retrospective study showed increased detection rates of COVID-19 for admitted orthopedic patients when testing all admitted patients compared with testing based on clinical suspicion (7.14% vs 33.3% after surgery) [24]. Our study could not establish whether limiting testing was due to significant variation in infection rates across provinces during the study period or due to potentially limited laboratory capacity.…”

Establishment of a novel triage system for SARS-CoV-2 among trauma victims in trauma centers with limited facilities

“…Porcel et al recommended evaluating all patients with the RT-PCR test to find asymptomatic, positive cases in trauma patients with low-energy fractures. 20 As mentioned above, we (and other low- and middle-income countries) cannot run this system due to our limitations.…”

Development of RT-PCR Based Diagnosis of SARS-CoV-2

“…One cohort study found that patients even if not having any symptoms still may be the carrier for viruses thus RT-PCR can detect those at genetic level. Thus, it helps in prevention of nosocomial infection and further spread unknowingly [10].…”

“…Self-collected saliva specimens was tested with 6 different molecular diagnostic tests like RTqPCR LDT, SARS-CoV-2 RAT, 3 direct RT-qPCR kits, and RT-LAMP and all tests showed a excellent results. Thus, based on these results, molecular diagnostic method has a great scope ahead [30]. Dr. Aneesh Mehta said that saliva test for coronavirus by PCR is the new type of diagnosis, as it is not invasive method but just spit is required as a sample [31].…”