The broad spectrum of COVID-like patients initially negative at RT-PCR testing: a cohort study

Abstract

Background Patients that arrive in the emergency department (ED) with COVID-19-like syndromes testing negative at the first RT-PCR represent a clinical challenge because of the lack of evidence about their management available in the literature. Our first aim was to quantify the proportion of patients testing negative at the first RT-PCR performed in our Emergency Department (ED) that were confirmed as having COVID-19 at the end of hospitalization by clinical judgment or by any subsequent microbiological testing. Secondly, we wanted to identify which variables that were available in the first assessment (ED variables) would have been useful in predicting patients, who at the end of the hospital stay were confirmed as having COVID-19 (false-negative at the first RT-PCR). Methods We retrospectively collected data of 115 negative patients from2020, March 1st to 2020, May 15th. Three experts revised patients’ charts collecting information on the whole hospital stay and defining patients as COVID-19 or NOT-COVID-19. We compared ED variables in the two groups by univariate analysis and logistic regression. Results We classified 66 patients as COVID-19 and identified the other 49 as having a differential diagnosis (NOT-COVID), with a concordance between the three experts of 0.77 (95% confidence interval (95%CI) 0.66- 0.73). Only 15% of patients tested positive to a subsequent RT-PCR test, accounting for 25% of the clinically suspected. Having fever (odds ratio (OR) 3.32, (95%CI 0.97-12.31), p = 0.06), showing a typical pattern at the first lung ultrasound (OR 6.09, (95%CI 0.87-54.65), p = 0.08) or computed tomography scan (OR 4.18, (95%CI 1.11-17.86), p = 0.04) were associated with a higher probability of having COVID-19. Conclusions In patients admitted to ED with COVID-19 symptoms and negative RT-PCR a comprehensive clinical evaluation integrated with lung ultrasound and computed tomography could help to detect COVID-19 patients with a false negative RT-PCR result.

Comparison of coagulation profile and thromboembolic events among patients undergoing spinal surgery before and after COVID-19 pandemic

“…The first scenario is the subclinical involvement of patients undergoing spinal surgery during COVID-19 patients. In that case, an asymptomatic COVID-19 and a false negative PCR test [ 20 ] might be an underlying cause for the coagulation impairment during the COVID-19 pandemic and thereby increasing the risk of thromboembolic events. The second scenario is the sustained coagulation activation during the post-COVID-19 infection.…”

Prevalence of Sexual Dysfunction and Domestic Violence During Quarantine of COVID 19

“…Factors such as age distribution, population density, political ideology, and socioeconomic conditions all affect how successful social distancing strategies are in reducing the spread of COVID-19 over the world. [19].…”

“New Normal” Radiology

“…A medical emergency room (ER) discovered that 60% of the patients who tested negative for COVID-19 had the infection, 8 thus indicating that false negatives through testing are an issue, even in a medical ER. As “more evidence is needed about the effectiveness of testing outside of hospital settings and in mild or asymptomatic cases,” 9 the dentist should continue to assume that each patient who is asymptomatic for COVID-19 might be infectious, as it is possible “that the oral cavity actively participates in SARS-CoV-2 transmission.” 10 Enhanced history-taking and donning and doffing personal protective equipment in the appropriate manner, effective room ventilation, and cleansing and sterilisation (or disinfection) of equipment 1 protect not only dentists and their patients but also particularly those with underlying conditions that place them at a heightened risk for a severe or fatal outcome if COVID-19 is contracted. 11 …”