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10.4269/ajtmh.20-0730

http://scihub22266oqcxt.onion/10.4269/ajtmh.20-0730
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33534752!7957242!33534752
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suck abstract from ncbi


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pmid33534752      Am+J+Trop+Med+Hyg 2021 ; 104 (3_Suppl): 34-47
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  • Pragmatic Recommendations for the Use of Diagnostic Testing and Prognostic Models in Hospitalized Patients with Severe COVID-19 in Low- and Middle-Income Countries #MMPMID33534752
  • Schultz MJ; Gebremariam TH; Park C; Pisani L; Sivakorn C; Taran S; Papali A
  • Am J Trop Med Hyg 2021[Jan]; 104 (3_Suppl): 34-47 PMID33534752show ga
  • Management of patients with severe or critical COVID-19 is mainly modeled after care of patients with severe pneumonia or acute respiratory distress syndrome from other causes. These models are based on evidence that primarily originates from investigations in high-income countries, but it may be impractical to apply these recommendations to resource-restricted settings in low- and middle-income countries (LMICs). We report on a set of pragmatic recommendations for microbiology and laboratory testing, imaging, and the use of diagnostic and prognostic models in patients with severe COVID-19 in LMICs. For diagnostic testing, where reverse transcription-PCR (RT-PCR) testing is available and affordable, we recommend using RT-PCR of the upper or lower respiratory specimens and suggest using lower respiratory samples for patients suspected of having COVID-19 but have negative RT-PCR results for upper respiratory tract samples. We recommend that a positive RT-PCR from any anatomical source be considered confirmatory for SARS-CoV-2 infection, but, because false-negative testing can occur, recommend that a negative RT-PCR does not definitively rule out active infection if the patient has high suspicion for COVID-19. We suggest against using serologic assays for the detection of active or past SARS-CoV-2 infection, until there is better evidence for its usefulness. Where available, we recommend the use of point-of-care antigen-detecting rapid diagnostic testing for SARS-CoV-2 infection as an alternative to RT-PCR, only if strict quality control measures are guaranteed. For laboratory testing, we recommend a baseline white blood cell differential platelet count and hemoglobin, creatinine, and liver function tests and suggest a baseline C-reactive protein, lactate dehydrogenase, troponin, prothrombin time (or other coagulation test), and D-dimer, where such testing capabilities are available. For imaging, where availability of standard thoracic imaging is limited, we suggest using lung ultrasound to identify patients with possible COVID-19, but recommend against its use to exclude COVID-19. We suggest using lung ultrasound in combination with clinical parameters to monitor progress of the disease and responses to therapy in COVID-19 patients. We currently suggest against using diagnostic and prognostic models as these models require extensive laboratory testing and imaging, which often are limited in LMICs.
  • |*Developing Countries[MESH]
  • |*Practice Guidelines as Topic[MESH]
  • |*Severity of Illness Index[MESH]
  • |COVID-19 Testing/methods/*standards[MESH]
  • |COVID-19/*diagnosis/pathology[MESH]
  • |Clinical Laboratory Techniques/methods/standards[MESH]
  • |False Negative Reactions[MESH]
  • |False Positive Reactions[MESH]
  • |Hospitalization/*statistics & numerical data[MESH]
  • |Humans[MESH]
  • |Point-of-Care Systems[MESH]
  • |Prognosis[MESH]
  • |SARS-CoV-2/genetics[MESH]
  • |Sensitivity and Specificity[MESH]


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