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

Erika Poggiali, Enrico Fabrizi, Davide Bastoni, Teresa Iannicelli, Claudia Galluzzo, Chiara Canini, Maria Grazia Cillis, Davide Giulio Ponzi, Andrea Magnacavallo and Andrea Vercelli
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Erika Poggiali: Emergency Department, “Guglielmo da Saliceto” Hospital, 29121 Piacenza, Italy
Enrico Fabrizi: DISES & DSS, Università Cattolica del Sacro Cuore, 29122 Piacenza, Italy
Davide Bastoni: Emergency Department, “Guglielmo da Saliceto” Hospital, 29121 Piacenza, Italy
Teresa Iannicelli: Emergency Department, “Guglielmo da Saliceto” Hospital, 29121 Piacenza, Italy
Claudia Galluzzo: Emergency Department, “Guglielmo da Saliceto” Hospital, 29121 Piacenza, Italy
Chiara Canini: Emergency Department, “Guglielmo da Saliceto” Hospital, 29121 Piacenza, Italy
Maria Grazia Cillis: Emergency Department, “Guglielmo da Saliceto” Hospital, 29121 Piacenza, Italy
Davide Giulio Ponzi: Emergency Department, “Guglielmo da Saliceto” Hospital, 29121 Piacenza, Italy
Andrea Magnacavallo: Emergency Department, “Guglielmo da Saliceto” Hospital, 29121 Piacenza, Italy
Andrea Vercelli: Emergency Department, “Guglielmo da Saliceto” Hospital, 29121 Piacenza, Italy

IJERPH, 2022, vol. 19, issue 13, 1-14

Abstract: 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.

Keywords: COVID-19; SARS-CoV-2; lung ultrasound; emergency department; triage; score (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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