Finke M, Pin M, Bernhard M, Rovas A, Pavenstädt H-J, Kümpers P
Medizinische Klinik D (Allg. Innere Medizin und Notaufnahme sowie Nieren- und Hochdruckkrankheiten und Rheumatologie), Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland.
Zentrale interdisziplinäre Notaufnahme, Florence-Nightingale-Krankenhaus der Kaiserswerther Diakonie, Düsseldorf, Deutschland.
Med Klin Intensivmed Notfmed. 2022 Mar;117(2):112-119. doi: 10.1007/s00063-021-00775-7. Epub 2021 Jan 24.
Since the beginning of the coronavirus disease 19 (COVID-19) pandemic, German emergency departments (ED) have been working in the area of conflict between high case load and demanding hygienic and organizational challenges. The aim of this study was to gain an overview of the current status of isolation measures, diagnostics and patient allocation of suspected COVID-19 cases.
Supported by the German Society for Interdisciplinary Emergency and Acute Medicine (DGINA) we invited leading ED physicians to answer an anonymous online survey regarding isolation measures, diagnostics and organization in emergency rooms during the COVID-19 pandemic.
A total of 139 responders from all federal states and all levels of care took part in the survey. Standard operating procedures on COVID-19 exist in almost all participating EDs, although concrete measures to end isolation are often missing. Most EDs screen patients for the "classic" COVID-19 symptoms such as fever, respiratory symptoms or contact to positive subjects in a standardized fashion, although the threshold for prophylactic isolation varies greatly. The individual swab-testing and allocation strategies vary relatively strongly. Less than half of all EDs have a separate procedure for uninterrogatable patients (e.g. major trauma). In about 8% of suspected cases, COVID-19-specific thoracic computed tomography is performed in the ED.
The current survey shows that the German EDs are well positioned for the moment, even though the isolation threshold is too high at some locations. In view of a possible increase in the number of cases during the winter season, a more precise differentiation of the previous recommendations of the Robert Koch Institute, especially for emergency admission patients, would be desirable. In this context, we propose a universal algorithm for the (de-)isolation of suspect cases in the ED.
自冠状病毒病19（COVID-19）大流行开始以来，德国急诊科一直在高病例负荷与严格的卫生和组织挑战之间的冲突领域开展工作。本研究的目的是概述疑似COVID-19病例的隔离措施、诊断和患者分配的现状。
在德国跨学科急诊与急性医学协会（DGINA）的支持下，我们邀请了主要的急诊科医生回答一项关于COVID-19大流行期间急诊室隔离措施、诊断和组织的匿名在线调查。
来自所有联邦州和各级医疗机构的139名受访者参与了调查。几乎所有参与调查的急诊科都有关于COVID-19的标准操作程序，尽管通常缺少结束隔离的具体措施。大多数急诊科以标准化方式对患者进行“典型”COVID-19症状筛查，如发热、呼吸道症状或与阳性患者接触情况，尽管预防性隔离的阈值差异很大。个体拭子检测和分配策略差异相对较大。不到一半的急诊科有针对无法询问的患者（如严重创伤患者）的单独程序。在约8%的疑似病例中，在急诊科进行了COVID-19特异性胸部计算机断层扫描。
目前的调查表明，德国急诊科目前状况良好，尽管某些地方的隔离阈值过高。鉴于冬季病例数可能增加，希望对罗伯特·科赫研究所先前的建议进行更精确的区分，尤其是针对急诊入院患者。在此背景下，我们提出了一种用于急诊科疑似病例（解除）隔离的通用算法。
