False negative results in COVID-19 testing are well recognised and frequently discussed. False positive results, while less common and less frequently discussed, still have several adverse implications, including potential exposure of a non-infected person to the virus in a cohorted area. Although false positive results are proportionally greater in low prevalence settings, the consequences are significant at all times and potentially of greater significance in high-prevalence settings. We evaluated COVID-19 results in one area during a period of low prevalence. The consequences of these results are discussed and implications for these results in both high and low prevalence settings are considered. We also provide recommendations to minimise the risk and impact of false-positive results.

Background This study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Methods This was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January–October 2019) and the second during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Both included patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines. Patient selection and rates of 30-day postoperative pulmonary complications were compared. The primary outcome was 30-day postoperative mortality. Mediation analysis using a natural-effects model was used to estimate the proportion of deaths during the pandemic attributable to SARS-CoV-2 infection. Results This study included 7402 patients from 50 countries; 3031 (40.9 per cent) underwent surgery before and 4371 (59.1 per cent) during the pandemic. Overall, 4.3 per cent (187 of 4371) developed postoperative SARS-CoV-2 in the pandemic cohort. The pulmonary complication rate was similar (7.1 per cent (216 of 3031) versus 6.3 per cent (274 of 4371); P = 0.158) but the mortality rate was significantly higher (0.7 per cent (20 of 3031) versus 2.0 per cent (87 of 4371); P < 0.001) among patients who had surgery during the pandemic. The adjusted odds of death were higher during than before the pandemic (odds ratio (OR) 2.72, 95 per cent c.i. 1.58 to 4.67; P < 0.001). In mediation analysis, 54.8 per cent of excess postoperative deaths during the pandemic were estimated to be attributable to SARS-CoV-2 (OR 1.73, 1.40 to 2.13; P < 0.001). Conclusion Although providers may have selected patients with a lower risk profile for surgery during the pandemic, this did not mitigate the likelihood of death through SARS-CoV-2 infection. Care providers must act urgently to protect surgical patients from SARS-CoV-2 infection.

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BackgroundBleeding per rectum in infants and children is often an alarming symptom for caregivers. The differential diagnosis is wide, from the benign to life-threatening. The current literature is limited on the description of this undifferentiated population in the UK. We aimed to describe the frequency of this presentation, the most common diagnoses and current management in the Paediatric Emergency Department (PED).Method and resultsRetrospective case note review of all patients presenting to a tertiary PED within a two year period from April 2017 to March 2019, with blood in stool/per rectum. Cases were identified by reviewing all presenting complaints including the words ‘blood’ or ‘bleed’. Data was collected using a standardised data collection form for the following variables; age, sex, diagnosis in PED, urgent intervention required, diagnosis on follow-up, diagnostic concordance between PED and follow-up diagnosis, investigation (stool, blood, imaging), admission, outpatient referral and reattendance during thestudy period.ConclusionsA total of 90 cases were identified, 10 were excluded as they did not meet inclusion criteria (n=80). This made up 0.14% of all presentations to the PED within the two year period. Mean age was 5 years (3 months - 15 years) with 51% female and 49% male. Collectively constipation and gastroenteritis accounted for 76% of diagnoses. 24% of patients were admitted the same day and 38% referred for outpatient follow up. There was agreement between PED diagnosis and outpatient diagnosis in 87% of cases. 5% of cases required urgent intervention.Bleeding per rectum is an infrequent presentation to the PED. The most common diagnoses are benign and many cases may be managed without need of admission or outpatient follow up. A high index of suspicion remains necessary to identify infrequent but serious pathology. There is currently limited evidence to guide practice and therefore further work is required.

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