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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 JAMA+Netw+Open
2020 ; 3
(7
): e2014549
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Clinical Characteristics of Patients With Coronavirus Disease 2019 (COVID-19)
Receiving Emergency Medical Services in King County, Washington
#MMPMID32639570
Yang BY
; Barnard LM
; Emert JM
; Drucker C
; Schwarcz L
; Counts CR
; Murphy DL
; Guan S
; Kume K
; Rodriquez K
; Jacinto T
; May S
; Sayre MR
; Rea T
JAMA Netw Open
2020[Jul]; 3
(7
): e2014549
PMID32639570
show ga
IMPORTANCE: The ability to identify patients with coronavirus disease 2019
(COVID-19) in the prehospital emergency setting could inform strategies for
infection control and use of personal protective equipment. However, little is
known about the presentation of patients with COVID-19 requiring emergency care,
particularly those who used 911 emergency medical services (EMS). OBJECTIVE: To
describe patient characteristics and prehospital presentation of patients with
COVID-19 cared for by EMS. DESIGN, SETTING, AND PARTICIPANTS: This retrospective
cohort study included 124 patients who required 911 EMS care for COVID-19 in King
County, Washington, a large metropolitan region covering 2300 square miles with
2.2 million residents in urban, suburban, and rural areas, between February 1,
2020, and March 18, 2020. EXPOSURES: COVID-19 was diagnosed by reverse
transcription-polymerase chain reaction detection of severe acute respiratory
syndrome coronavirus 2 from nasopharyngeal swabs. Test results were available a
median (interquartile range) of 5 (3-9) days after the EMS encounter. MAIN
OUTCOMES AND MEASURES: Prevalence of clinical characteristics, symptoms,
examination signs, and EMS impression and care. RESULTS: Of the 775 confirmed
COVID-19 cases in King County, EMS responded to 124 (16.0%), with a total of 147
unique 911 encounters. The mean (SD) age was 75.7 (13.2) years, 66 patients
(53.2%) were women, 47 patients (37.9%) had 3 or more chronic health conditions,
and 57 patients (46.0%) resided in a long-term care facility. Based on EMS
evaluation, 43 of 147 encounters (29.3%) had no symptoms of fever, cough, or
shortness of breath. Based on individual examination findings, fever, tachypnea,
or hypoxia were only present in a limited portion of cases, as follows: 43 of 84
encounters (51.2%), 42 of 131 (32.1%), and 60 of 112 (53.6%), respectively.
Advanced care was typically not required, although in 24 encounters (16.3%),
patients received care associated with aerosol-generating procedures. As of June
1, 2020, mortality among the study cohort was 52.4% (65 patients). CONCLUSIONS
AND RELEVANCE: The findings of this cohort study suggest that screening based on
conventional COVID-19 symptoms or corresponding examination findings of febrile
respiratory illness may not possess the necessary sensitivity for early
diagnostic suspicion, at least in the prehospital emergency setting. The findings
have potential implications for early identification of COVID-19 and effective
strategies to mitigate infectious risk during emergency care.