COVID-19 Preliminary Case Series: Characteristics of EMS Encounters with Linked Hospital Diagnoses

Fernández, Antonio R. Martínez; Crowe, Remle P.; Bourn, Scott S.; Matt, Sarah E.; Brown, Andrew; Hawthorn, Andrew B.; Myers, Jennifer

doi:10.1080/10903127.2020.1792016

Cited by 25 publications

(30 citation statements)

References 13 publications

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“…Our results were in line with a previous investigation by Fernandez et al of the sensitivity of Covid-19 suspicion documented in free-text notes written by ambulance crews, but given the substantial difference in overall prevalence of Covid-19 between these studies (5% here vs. 1% in Fernandez et al) comparisons should be made only with caution, particularly with regards to speci city (11). In examining the characteristics of Covid-19 patients presenting to the prehospital care system in this region, we found a 24% rate of 30-day mortality, which is congruent with preliminary investigations of hospitalized patients diagnosed with Covid-19 in Denmark, Norway, and Italy (23,25,26).…”

Section: Generalizabilitysupporting

confidence: 92%

“…Despite the signi cant Covid-19 related scienti c output (7), only a few studies describing the effect of the Covid-19 pandemic on prehospital care systems are available (8)(9)(10), and these are largely limited to reports on the impact of the pandemic at the system-level. Only a single study has been published which quantitatively investigates the characteristics of Covid-19 patients and/or the ability of prehospital care providers to identify SARS-CoV-2-positive patients by linking prehospital data with subsequent hospital diagnoses (11). In this study, Fernandez et al found that Covid-19 patients more often presented to prehospital care providers with tachycardia, tachypnea, hypoxia, and fever, and found a sensitivity of 78% for ambulance crews in identifying con rmed Covid-19 patients based on an analysis of structured documentation and free text notes.…”

Section: Introductionmentioning

confidence: 99%

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Prehospital Identification of Covid-19: An Observational Study

Spangler

Blomberg

Smékal

2020

Preprint

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Background The novel coronavirus disease 2019 (Covid-19) pandemic has affected prehospital care systems across the world, but the prehospital presentation of affected patients and the extent to which prehospital care providers are able to identify them is not well characterized. In this study, we describe the presentation of Covid-19 patients in a Swedish prehospital care system, and asses the predictive value of Covid-19 suspicion as documented by dispatch and ambulance nurses.Methods Data for all patients with dispatch, ambulance, and hospital records between January 1 - August 31, 2020 were extracted. A descriptive statistical analysis of patients with and without hospital-confirmed Covid-19 was performed. In a subset of records beginning from April 14, we assessed the sensitivity and specificity of documented Covid-19 suspicion in dispatch and ambulance patient care records.Results A total of 11 894 prehospital records were included, of which 481 had a primary hospital diagnosis code related to-, or positive test results for Covid-19. Covid-19-positive patients had considerably worse outcomes than patients with negative test results, with 30-day mortality rates of 24% vs 11%, but lower levels of prehospital acuity (e.g. emergent transport rates of 14% vs 22%). About half (46%) of Covid-19-positive patients presented to dispatchers with primary complaints typically associated with Covid-19. 6 776 of records were included in the assessment of predictive value. Sensitivity was 76% (95% CI 71 - 80) and 82% (78 - 86) for dispatch and ambulance suspicion respectively, while specificities were 86% (85 - 87) and 78% (77 - 79).Conclusions While prehospital suspicion was strongly indicative of hospital-confirmed Covid-19, based on the sensitivity identified in this study, prehospital suspicion should not be relied upon as a single factor to rule out the need for isolation precautions. The data provided may be used to develop improved guidelines for identifying Covid-19 patients in the prehospital setting.

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Section: Generalizabilitysupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Prehospital Identification of Covid-19: An Observational Study

Spangler

Blomberg

Smékal

2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Longitudinal shifts in predictive value were assessed by plotting each measure grouped by month. Given the potential for bias due to missed cases of Covid-19 among assumed negative patients, we analyzed statistics based both on the assumption that untested patients were negative per the study by Fernandez et al [ 11 ], and a sensitivity analysis investigating only PCR-test results. All analyses were performed using R version 4.0.2 [ 16 ].…”

Section: Methodsmentioning

confidence: 99%

“…Despite the significant Covid-19 related scientific output [ 7 ], only a few studies describing the effect of the Covid-19 pandemic on prehospital care systems are available [ 8 – 10 ], and these are largely limited to reports on the impact of the pandemic at the system-level. Only a single study has been published which quantitatively investigates the characteristics of Covid-19 patients and/or the ability of prehospital care providers to identify SARS-CoV-2-positive patients by linking prehospital data with subsequent hospital diagnoses [ 11 ]. In this study, Fernandez et al found that Covid-19 patients more often presented to prehospital care providers with tachycardia, tachypnea, hypoxia, and fever, and found a sensitivity of 78% for ambulance crews in identifying confirmed Covid-19 patients based on an analysis of structured documentation and free text notes.…”

Section: Introductionmentioning

confidence: 99%

Prehospital identification of Covid-19: an observational study

Spangler

Blomberg

Smékal

2021

Scand J Trauma Resusc Emerg Med

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Background The novel coronavirus disease 2019 (Covid-19) pandemic has affected prehospital care systems across the world, but the prehospital presentation of affected patients and the extent to which prehospital care providers are able to identify them is not well characterized. In this study, we describe the presentation of Covid-19 patients in a Swedish prehospital care system, and asses the predictive value of Covid-19 suspicion as documented by dispatch and ambulance nurses. Methods Data for all patients with dispatch, ambulance, and hospital records between January 1–August 31, 2020 were extracted. A descriptive statistical analysis of patients with and without hospital-confirmed Covid-19 was performed. In a subset of records beginning from April 14, we assessed the sensitivity and specificity of documented Covid-19 suspicion in dispatch and ambulance patient care records. Results A total of 11,894 prehospital records were included, of which 481 had a primary hospital diagnosis code related to-, or positive test results for Covid-19. Covid-19-positive patients had considerably worse outcomes than patients with negative test results, with 30-day mortality rates of 24% vs 11%, but lower levels of prehospital acuity (e.g. emergent transport rates of 14% vs 22%). About half (46%) of Covid-19-positive patients presented to dispatchers with primary complaints typically associated with Covid-19. Six thousand seven hundred seventy-six records were included in the assessment of predictive value. Sensitivity was 76% (95% CI 71–80) and 82% (78–86) for dispatch and ambulance suspicion respectively, while specificities were 86% (85–87) and 78% (77–79). Conclusions While prehospital suspicion was strongly indicative of hospital-confirmed Covid-19, based on the sensitivity identified in this study, prehospital suspicion should not be relied upon as a single factor to rule out the need for isolation precautions. The data provided may be used to develop improved guidelines for identifying Covid-19 patients in the prehospital setting.

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“…The Modified Early Warning Score (MEWS) (12) and the National Early Warning Score (NEWS) (13) have shown prognostic value in the prehospital setting as predictors of hospital mortality (14,15). However, these scores incorporate patient body temperature, which is not consistently and reliably obtained in the prehospital setting (16,17). The Acute Physiology and Chronic Health Evaluation (APACHE-II) is widely used in the hospital setting to predict mortality; however, this 71-point score includes laboratory values that are not routinely obtained in the prehospital environment (18).…”

Section: Accepted Manuscriptmentioning

confidence: 99%