Introduction We assessed the utility of an emergency department (ED) protocol using clinical parameters to rapidly distinguish likelihood of novel coronavirus 2019 (COVID-19) infection; the applicability aimed to stratify infectious-risk pre-polymerase chain reaction (PCR) test results and accurately guide early patient cohorting decisions. Methods We performed this prospective study over a two-month period during the initial surge of the 2020 COVID-19 pandemic in a busy urban ED of patients presenting with respiratory symptoms who were admitted for in-patient care. Per protocol, each patient received assessment consisting of five clinical parameters: presence of fever; hypoxia; cough; shortness of breath/dyspnea; and performance of a chest radiograph to assess for bilateral pulmonary infiltrates. All patients received nasopharyngeal COVID-19 PCR testing. Results Of 283 patients studied, 221 (78%) were PCR+ and 62 (22%) PCR-. Chest radiograph revealed bilateral pulmonary infiltrates in 85%, which was significantly more common in PCR+ (94%) vs PCR- (52%) patients (P < 0.0001). The rate of manifesting all five positive clinical parameters was significantly greater in PCR+ (63%) vs PCR- (6.5%) patients (P < 0.0001). For PCR+ outcome, the presence of all five positive clinical parameters had a specificity of 94%, positive predictive value of 98%, and positive likelihood ratio of 10. Conclusions Using an ED protocol to rapidly assess five clinical parameters accurately distinguishes likelihood of COVID-19 infection prior to PCR test results, and can be used to augment early patient cohorting decisions.
【초록키워드】 COVID-19, protocol, Prospective Study, outcome, Novel coronavirus, specificity, PCR testing, PCR, Positive predictive value, COVID-19 infection, nasopharyngeal, Chest, Patient, PCR test, utility, Chest radiograph, Care, bilateral pulmonary infiltrates, respiratory symptom, likelihood ratio, applicability, positive, clinical parameter, 2020 COVID-19 pandemic, FIVE, likelihood, initial, Result, greater, performed, significantly more, significantly, can be used, presenting, bilateral pulmonary infiltrate, 【제목키워드】 clinical, Emergency, identification, Department,