Prehospital identification of Covid-19: an observational study

Abstract

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.

Physiological respiratory parameters in pre-hospital patients with suspected COVID-19: A prospective cohort study

“…Somewhat surprisingly, the oxygen saturation levels did not differ between the patients with and without COVID-19 in this study. Previous pre-hospital studies [ 4 , 20 ] have found lower oxygen saturation levels in all pre-hospital patients with COVID-19 confirmed later on. In our study we had the aim of including all COVID-19 patients and therefore we might have two archetypes of COVID-19 patients in the present study.…”

“…The odds of hospital admission increased with increasing respiratory rate (OR 1.196, 95% CI 1.081–1.324, p = 0.001), rapid shallow breathing index (OR 1.023, 95% CI 1.006–1.040, p = 0.009) and dead space percentage of tidal volume (OR 1.091, 95% CI 1.027–1.159 p = 0.005). A higher respiratory rate among hospitalized patients seems logical as there is evidence that increased respiratory rate is a predictor for hospital admissions, ICU admissions and mortality [ 20 – 23 ]. Higher dead space fraction has also been found in severe COVID-19 [ 24 ] and non COVID-19 related ARDS [ 25 ].…”

Prehospital characteristics of COVID-19 patients in Helsinki – experience of the first wave of the pandemic

“…A recent study from Sweden found that up to 54% of COVID-19 patients presented with primary symptoms not typical of COVID-19 [ 14 ]. This proportion was markedly higher than in our study (19%) and it may reflect differences how people with non-severe symptoms use emergency services.…”

Sort and Sieve: Pre-Triage Screening of Patients with Suspected COVID-19 in the Emergency Department

“…All 13 under-triaged patients were 65 year or older and the majority presented with gastro-intestinal or non-specific symptoms. Previous studies have illustrated that up to 50% of SARS-CoV-2 infections can manifest with gastro-intestinal or atypical symptoms [17,18,42] and that these patients arouse the least suspicion for a COVID-19 infection [43]. In a Belgian screening protocol study, atypical symptoms including confusion, repeated falls and altered general state in patients >75 years of age were additionally considered as signs of possible COVID-19 infection [20].…”