Department of Public Health, University of Otago, Wellington, Wellington, New Zealand.
Department of Surgery and Anaesthesia, University of Otago, Wellington, Wellington, New Zealand.
Emerg Med Australas. 2023 Oct;35(5):812-820. doi: 10.1111/1742-6723.14237. Epub 2023 May 14.
To review if tests for suspected COVID-19 were performed according to the Ministry of Health (MoH) case definitions, identify patterns associated with testing outside of the case definition, and discuss the potential impacts on hospital services.
This was a retrospective audit of patients presenting to the Wellington Hospital ED between 24 March 2020 and 27 April 2020 who were swabbed for COVID-19 in ED. Swabs were audited against the March 15th and April 8th MoH COVID-19 case definitions.
Five hundred and thirty-six COVID-19 swabs for 518 patients were taken during the study period. There was poor alignment of testing with the March 15th case definition, with only 11.6% of the 164 swabs taken during this period meeting the case definition. Of the 145 swabs that did not meet the case definition, the majority (n = 119, 82.1%) met symptom criteria only. Alignment of testing with the wider April 8th case definition was much higher with 88.2% meeting criteria. Factors associated with being swabbed despite not meeting the case definitions included fever >38°, a diagnosis of cancer, subsequent hospital admission, and for the March case definition only 'contact with a traveller'.
There were associations found between testing outside of criteria and specific variables potentially perceived as high-risk. Poor alignment of testing with case definitions can impact hospital services through the (mis)use of limited laboratory testing capacity and implications for resource management. Improved communication and feedback between clinicians and policymakers may improve case definition implementation in a clinical setting.
回顾疑似 COVID-19 病例是否根据卫生部（MoH）的病例定义进行了检测，确定不符合病例定义的检测模式，并讨论其对医院服务的潜在影响。
这是对 2020 年 3 月 24 日至 4 月 27 日期间在惠灵顿医院急诊部就诊并接受 COVID-19 检测的患者进行的回顾性审核。对 3 月 15 日和 4 月 8 日的 MoH COVID-19 病例定义进行了检测。
研究期间共采集了 518 名患者的 536 份 COVID-19 检测拭子。与 3 月 15 日病例定义的检测结果不一致，仅 164 份检测拭子符合病例定义，占该时期检测拭子的 11.6%。在不符合病例定义的 145 份检测拭子中，大多数（n=119，82.1%）仅符合症状标准。与更广泛的 4 月 8 日病例定义的检测结果更为一致，符合标准的占 88.2%。不符合病例定义但仍进行检测的因素包括体温>38°C、癌症诊断、随后住院治疗，以及仅在 3 月病例定义中与旅行者有过接触。
在不符合标准的检测中发现了与特定变量之间的关联，这些变量可能被认为是高风险的。检测与病例定义之间的不一致会通过（错误）使用有限的实验室检测能力对医院服务产生影响，并对资源管理产生影响。临床医生和决策者之间加强沟通和反馈可能会改善病例定义在临床环境中的实施。
