Department of Oncology, Santa Maria della Misericordia Hospital, Udine, Italy.
Department of Hematology, Santa Maria della Misericordia Hospital, Udine, Italy.
Oncologist. 2021 Apr;26(4):e694-e703. doi: 10.1002/onco.13706. Epub 2021 Feb 19.
Triage procedures have been implemented to limit hospital access and minimize infection risk among patients with cancer during the coronavirus disease (COVID-19) outbreak. In the absence of prospective evidence, we aimed to evaluate the predictive performance of a triage system in the oncological setting.
This retrospective cohort study analyzes hospital admissions to the oncology and hematology department of Udine, Italy, during the COVID-19 pandemic (March 30 to April 30, 2020). A total of 3,923 triage procedures were performed, and data of 1,363 individual patients were reviewed.
A self-report triage questionnaire identified 6% of triage-positive procedures, with a sensitivity of 66.7% (95% confidence interval [CI], 43.0%-85.4%), a specificity of 94.3% (95% CI, 93.5%-95.0%), and a positive predictive value of 5.9% (95% CI, 4.3%-8.0%) for the identification of patients who were not admitted to the hospital after medical review. Patients with thoracic cancer (odds ratio [OR], 1.69; 95% CI, 1.13-2.53, p = .01), younger age (OR, 1.52; 95% CI, 1.15-2.01, p < .01), and body temperature at admission ≥37°C (OR, 9.52; 95% CI, 5.44-16.6, p < .0001) had increased risk of positive triage. Direct hospital access was warranted to 93.5% of cases, a further 6% was accepted after medical evaluation, whereas 0.5% was refused at admission.
A self-report questionnaire has a low positive predictive value to triage patients with cancer and suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) symptoms. Differential diagnosis with tumor- or treatment-related symptoms is always required to avoid unnecessary treatment delays. Body temperature measurement improves the triage process's overall sensitivity, and widespread SARS-CoV-2 testing should be implemented to identify asymptomatic carriers.
This is the first study to provide data on the predictive performance of a triage system in the oncological setting during the coronavirus disease outbreak. A questionnaire-based triage has a low positive predictive value to triage patients with cancer and suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) symptoms, and a differential diagnosis with tumor- or treatment-related symptoms is mandatory to avoid unnecessary treatment delays. Consequently, adequate recourses should be reallocated for a triage implementation in the oncological setting. Of note, body temperature measurement improves the overall sensitivity of the triage process, and widespread testing for SARS-CoV-2 infection should be implemented to identify asymptomatic carriers.
在冠状病毒病（COVID-19）爆发期间，分诊程序已被实施以限制癌症患者进入医院并最大程度降低感染风险。由于缺乏前瞻性证据，我们旨在评估肿瘤学环境中的分诊系统的预测性能。
本回顾性队列研究分析了意大利乌迪内的肿瘤学和血液科在 COVID-19 大流行期间（2020 年 3 月 30 日至 4 月 30 日）的住院情况。共进行了 3923 次分诊程序，回顾了 1363 名患者的数据。
自我报告的分诊问卷确定了 6%的分诊阳性程序，其敏感性为 66.7%（95%置信区间 [CI]，43.0%-85.4%），特异性为 94.3%（95%CI，93.5%-95.0%），阳性预测值为 5.9%（95%CI，4.3%-8.0%），用于识别经医学审查后无需住院的患者。胸部癌症患者（比值比 [OR]，1.69；95%CI，1.13-2.53，p=0.01）、年龄较小（OR，1.52；95%CI，1.15-2.01，p<.01）和入院时体温≥37°C（OR，9.52；95%CI，5.44-16.6，p<.0001）的患者，其阳性分诊的风险增加。93.5%的病例需要直接进入医院，另外 6%的病例经医学评估后可以接受，而 0.5%的病例在入院时被拒绝。
自我报告的问卷对有癌症和疑似严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）症状的患者进行分诊的阳性预测值较低。需要进行肿瘤或治疗相关症状的鉴别诊断，以避免不必要的治疗延误。体温测量可提高分诊过程的整体敏感性，应广泛进行 SARS-CoV-2 检测以识别无症状携带者。
这是第一项在冠状病毒病疫情期间提供肿瘤学环境中分诊系统预测性能数据的研究。基于问卷的分诊对有癌症和疑似严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）症状的患者的阳性预测值较低，并且必须与肿瘤或治疗相关症状进行鉴别诊断，以避免不必要的治疗延误。因此，应重新分配足够的资源用于肿瘤学环境中的分诊实施。值得注意的是，体温测量可提高分诊过程的整体敏感性，应广泛进行 SARS-CoV-2 检测以识别无症状携带者。
