Study Objective
We assessed the efficacy of an emergency department [ED] protocol to cohort admitted ED patients utilizing clinical parameters. These parameters were used to distinguish likelihood of novel coronavirus disease 2019 [COVID-19] in patients presenting with acute respiratory symptoms prior to testing results.
Methods
An prospective ongoing chart review was performed during April of the 2020 pandemic in a several busy urban ED on admitted, but boarding, ED patients who presented with acute respiratory symptoms clinically suspicious for COVID-19 infection. Each patient’s chart was reviewed for an assessment of five clinical parameters in patients who were felt by the attending physician to have COVID-19: presence of fever, cough, hypoxia, and shortness of breath; and chest radiograph evaluating for bilateral pulmonary infiltrates. Chart reviews were performed prior to result of COVID-19 testing. All received performance of NP COVID-19 PCR testing.
Results
Of 225 patients studied, 190 [84%] were PCR+ and 35 [16%] PCR-. The manifestation of all 5 positive clinical parameters was present in 136 patients [61%]. The rate of manifesting all 5 positive clinical parameters was significantly greater in PCR+ [70%] vs PCR- [9%] patients [p < 0.0001]. For PCR+ outcome, the presence of all 5 positive clinical parameters had a specificity of 92%, positive-predictive value of 97%, and positive likelihood ratio of 8.1.
Conclusions
Utilizing an ED protocol assessing 5 clinical parameters in patients suspected of COVID-19 infection accurately distinguishes risk of infection with COVID-19 prior to PCR test results and can be used to guide early patient management decisions.