Mansella Gregory, Rueegg Marco, Widmer Andreas F, Tschudin-Sutter Sarah, Battegay Manuel, Hoff Julia, Søgaard Kirstine K, Egli Adrian, Stieltjes Bram, Leuzinger Karoline, Hirsch Hans H, Meienberg Andrea, Burkard Thilo, Mayr Michael, Bingisser Roland, Nickel Christian H
Emergency Department, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland.
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland.
J Clin Med. 2020 Oct 7;9(10):3217. doi: 10.3390/jcm9103217.
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.
这项前瞻性观察性研究评估了在新型冠状病毒肺炎（COVID-19）大流行早期，分诊与检测中心（TTC）低门槛检测流程的安全性和可行性。此外，我们旨在确定严重急性呼吸综合征冠状病毒2（SARS-CoV-2）咽拭子检测结果呈阳性的临床预测因素。患者仅在必要时接受非正式分诊、标准化病史采集和医生评估。对患者进行了30天的观察。安全性是主要结局，定义为前往TTC就诊的患者中与COVID-19相关的30天复诊率<5%且死亡率<1%。可行性定义为非正式分诊的推翻率<5%。在4815次就诊中，572例（11.9%）SARS-CoV-2检测呈阳性，4774例出院。30天死亡率为0.04%（2例患者，其中1例与COVID-19相关）。发热（比值比[OR]2.03[95%置信区间（CI）1.70；2.42]）、肌痛（OR 1.94[1.63；2.31]）、寒战（OR 1.77[1.44；2.16]）、头痛（OR 1.61[1.34；1.94]）、咳嗽（OR 1.50[1.24；1.83]）、虚弱（OR 1.46[1.21；1.76]）和意识模糊（OR 1.39[1.06；1.80]）与检测阳性相关。总体复诊率为8%，与COVID-19相关的复诊率为1.4%（4774例中的69例）。非正式分诊的推翻率为1.5%。根据我们的研究，TTC的低门槛检测流程似乎是安全的（低复诊率和低死亡率）且是可行的（非正式分诊的低推翻率）。仅基于临床参数进行COVID-19诊断似乎是不可能的。
