Kim Changho, Yeo In Hwan, Kim Jong Kun, Cho Yeonjoo, Lee Mi Jin, Jung Haewon, Cho Jae Wan, Ham Ji Yeon, Lee Suk Hee, Chung Han Sol, Mun You Ho, Lee Sang Hun, Kim Yang Hun
Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
Department of Clinical Pathology, School of Medicine, Kyungpook National University, Daegu, Korea.
Infect Chemother. 2020 Dec;52(4):562-572. doi: 10.3947/ic.2020.52.4.562. Epub 2020 Nov 24.
There is currently a lack of evidence-based postresuscitation or postmortem guidelines for patients with out-of-hospital cardiac arrest (OHCA) in the setting of an emerging infectious disease. This study aimed to develop and validate a multimodal screening tool that aids in predicting the disease confirmation in emergency situations and patients with OHCA during a coronavirus disease 2019 (COVID-19) outbreak.
We conducted a retrospective, multicenter observational study of adult patients with OHCA in Daegu, Korea. To identify the potential predictors that could be used in screening tools in the emergency department, we applied logistic regression to data collected from March 1 to March 14. The prediction performance of the screening variables was then assessed and validated on the data of patients with OHCA who were treated between February 19 and March 31, 2020. General patient characteristics and hematological findings of the COVID-19-negative and COVID-19-positive groups were compared. We also evaluated confirmation test criteria as predictors for COVID-19 positivity in patients with OHCA.
Advanced age, body temperature, and abnormal chest X-ray (CXR) revealed significant predictive ability in the derivation cohort. Of the 184 adult patients with OHCA identified in the validation cohort, 80 patients were included in the analysis. Notably, 9 patients were positive and 71 were negative on the COVID-19 reverse transcription polymerase chain reaction test. Five patients (55.6%) in the COVID-19-positive group had a fever before OHCA, and 12 (16.9%) of the COVID-19-negative group had a fever before OHCA ( = 0.018). Eight patients (88.9%) in the COVID-19-positive group had a CXR indicating pneumonic infiltration. Of the criteria for predicting COVID-19, fever or an abnormal CXR had a sensitivity of 100% (95% confidence interval [CI]: 65.4 - 100) and a specificity of 22.5% (95% CI: 13.5 - 34.0).
The screening tools that combined fever or abnormal CXR had a good discriminatory ability for COVID-19 infection in adult patients with OHCA. Therefore, during the COVID-19 outbreak period, it is recommended to suspect COVID-19 infection and perform COVID-19 test if patients present with a history of fever or show abnormal findings in postmortem CXR.
目前，对于院外心脏骤停（OHCA）患者在新发传染病背景下缺乏基于证据的复苏后或死后指南。本研究旨在开发并验证一种多模式筛查工具，以帮助预测在2019冠状病毒病（COVID-19）疫情期间急诊情况下及OHCA患者的疾病确诊情况。
我们对韩国大邱市成年OHCA患者进行了一项回顾性、多中心观察性研究。为了确定可用于急诊科筛查工具的潜在预测因素，我们对3月1日至3月14日收集的数据应用逻辑回归分析。然后，根据2020年2月19日至3月31日接受治疗的OHCA患者的数据，对筛查变量的预测性能进行评估和验证。比较了COVID-19阴性和阳性组患者的一般特征和血液学检查结果。我们还评估了确诊试验标准作为OHCA患者COVID-19阳性预测因素的情况。
高龄、体温和胸部X线（CXR）异常在推导队列中显示出显著的预测能力。在验证队列中确定的184例成年OHCA患者中，80例患者纳入分析。值得注意的是，在COVID-19逆转录聚合酶链反应试验中，9例患者呈阳性，71例呈阴性。COVID-19阳性组中有5例患者（55.6%）在OHCA前发热，COVID-19阴性组中有12例患者（16.9%）在OHCA前发热（P = 0.018）。COVID-19阳性组中有8例患者（88.9%）的CXR显示有肺部浸润。在预测COVID-19的标准中，发热或CXR异常的敏感性为100%（95%置信区间[CI]：65.4 - 100），特异性为22.5%（95%CI：13.5 - 34.0）。
结合发热或CXR异常的筛查工具对成年OHCA患者的COVID-19感染具有良好的鉴别能力。因此，在COVID-19疫情期间，如果患者有发热史或死后CXR显示异常，建议怀疑COVID-19感染并进行COVID-19检测。
