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10.5811/westjem.2020.12.49470

http://scihub22266oqcxt.onion/10.5811/westjem.2020.12.49470
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34125031!8203032!34125031
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suck abstract from ncbi


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pmid34125031      West+J+Emerg+Med 2021 ; 22 (3): 587-591
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  • Utility Of An Emergency Department Clinical Protocol For Early Identification of Coronavirus Infection #MMPMID34125031
  • Bonadio W; Jackson K; Gottlieb L; Legome E
  • West J Emerg Med 2021[Apr]; 22 (3): 587-591 PMID34125031show ga
  • INTRODUCTION: We assessed the utility of an emergency department (ED) protocol using clinical parameters to rapidly distinguish likelihood of novel coronavirus 2019 (COVID-19) infection; the applicability aimed to stratify infectious-risk pre-polymerase chain reaction (PCR) test results and accurately guide early patient cohorting decisions. METHODS: We performed this prospective study over a two-month period during the initial surge of the 2020 COVID-19 pandemic in a busy urban ED of patients presenting with respiratory symptoms who were admitted for in-patient care. Per protocol, each patient received assessment consisting of five clinical parameters: presence of fever; hypoxia; cough; shortness of breath/dyspnea; and performance of a chest radiograph to assess for bilateral pulmonary infiltrates. All patients received nasopharyngeal COVID-19 PCR testing. RESULTS: Of 283 patients studied, 221 (78%) were PCR+ and 62 (22%) PCR-. Chest radiograph revealed bilateral pulmonary infiltrates in 85%, which was significantly more common in PCR+ (94%) vs PCR- (52%) patients (P < 0.0001). The rate of manifesting all five positive clinical parameters was significantly greater in PCR+ (63%) vs PCR- (6.5%) patients (P < 0.0001). For PCR+ outcome, the presence of all five positive clinical parameters had a specificity of 94%, positive predictive value of 98%, and positive likelihood ratio of 10. CONCLUSIONS: Using an ED protocol to rapidly assess five clinical parameters accurately distinguishes likelihood of COVID-19 infection prior to PCR test results, and can be used to augment early patient cohorting decisions.
  • |COVID-19/*diagnosis/epidemiology/physiopathology[MESH]
  • |Clinical Protocols/*standards[MESH]
  • |Early Diagnosis[MESH]
  • |Emergency Service, Hospital/*organization & administration[MESH]
  • |Humans[MESH]
  • |Male[MESH]
  • |Middle Aged[MESH]
  • |Pandemics[MESH]
  • |Prospective Studies[MESH]
  • |Risk Assessment[MESH]


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