Separating the wheat from the chaff—COVID-19 in a German emergency department: a case-control study

Abstract

Background: COVID-19 pandemia is a major challenge to worldwide health care systems. Whereas the majority of disease presents with mild symptoms that can be treated as outpatients, severely ill COVID-19 patients and patients presenting with similar symptoms cross their ways in the emergency department. Especially, the variety of symptoms is challenging with primary triage. Are there parameters to distinguish between proven COVID-19 and without before? How can a safe and efficient management of these inpatients be achieved? Methods: We conducted a retrospective analysis of 314 consecutive inpatient patients who presented with possible symptoms of COVID-19 in a German emergency department between March and April 2020 and were tested with a SARS-Cov-2 nasopharyngeal swab. Clinical parameters, Manchester Triage System categories, and lab results were compared between patients with positive and negative test results for SARS-Cov-2. Furthermore, we present the existing COVID-19 workflow model of the university hospital in Essen which proved to be efficient during pandemia. Results: Forty-three of the 314 patients (13.7%) were tested positive for COVID-19 by SARS-Cov-2 nasopharyngeal swab. We did not find any laboratory parameter to distinguish safely between patients with COVID-19 and those with similar symptoms. Dysgeusia was the only clinical symptom that was significantly more frequent among COVID-19 patients. Conclusion: Dysgeusia seems to be a typical symptom for COVID-19, which occurred in 14% of our COVID-19 patients. However, no valid parameters could be found to distinguish clinically between COVID-19 and other diseases with similar symptoms. Therefore, early testing, a strict isolation policy, and proper personal protection are crucial to maintain workflow and safety of patients and ED staff for the months to come.

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

“…These findings are in line with studies from Italy (50%) [31] and Belgium (32.7%) [20], two European countries with a similar COVID-19 prevalence during the first wave [32,33]. By contrast, several other studies reported lower COVID-19 rates in ED patients, ranging from 3.8% to 13.7% [21,23,34,35]. In addition to epidemiological and demographic variations, these numbers may be explained by differences in hospital referral thresholds, lockdown regimes and ED utilisation rates for non-urgent complaints.…”

“…Various approaches to the screening and segregation of ED patients have been reported. Many hospitals included the set-up of external facilities with pre-triage prior to ED entrance in order to isolate high-risk patients in an early stage [19][20][21][22]. Others adjusted existing in-hospital areas into "high-and low-risk" zones, with screening mainly based on the presence or absence of fever and/or respiratory complaints [6,23,24].…”

“…To date, validated research on the performance of these approaches is limited, which complicates incorporation of these strategies by other EDs. Most previous studies focused on positive versus negative results of patients with suspected COVID-19 infection [21,23]. However, the patients that are initially screened negative (not COVID-19 suspected and therefore not isolated), but later appear to have a (asymptomatic or presymptomatic) COVID-19 infection may pose the greatest risk of nosocomial spread.…”

Global prevalence and pathogenesis of headache in COVID-19: A systematic review and meta-analysis

“…The rest of the references had been excluded for these reasons: (a) the studies were case reports or case-series (n=98); (b) the full-text did not include data of outcome of interest (n=84); and (c) low quality of study (n=3) ( Figure 1 ). The included studies were conducted in a wide ranges of regions: Australia 127 , Belgium 29 , Brazil 50 , China 70 , France 99 , Hongkong 128 , Israel 129 , Italy 130 , Germany 131 , Netherlands 31 , Turkey 120 , and the US 28 , 105 , 122 , 132 , 133 . Out of the studies, ten were case-control 28 , 29 , 31 , 99 , 105 , 120 , 128 , 130 , 132 , four were cross-sectional 50 , 70 , 122 , 131 , 133 , and two were prospective cohort studies 127 , 129 .…”

“…A total of 16 studies, consisting of 5,407 COVID-19 cases in adults and 94,818 adults with non-COVID-19 infections (mostly COVID-19-like respiratory viral infections), were analyzed to determine the association between headache and COVID-19. Of these studies, an association between headache and the occurrence of COVID-19 was observed in 9 studies 28 , 29 , 31 , 105 , 122 , 127 , 129 , 130 , 132 while seven studies reported no association 50 , 70 , 99 , 120 , 131 , 133 , 134 ( Table 2 ). Our cumulative calculation revealed that headache was found to be 1.7-fold more prevalent in patients with COVID-19 compared to those with non-COVID-19 respiratory viral infections, OR: 1.73; 95% CI: 1.94, 2.51 with p=0.04.…”