Top

International Journal of Emergency Medicine

Published in:

Open Access 01-12-2020 | Triage | Original Research

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

Authors: David Fistera, Dirk Pabst, Annalena Härtl, Benedikt Michael Schaarschmidt, Lale Umutlu, Sebastian Dolff, Carola Holzner, Clemens Kill, Joachim Risse

Published in: International Journal of Emergency Medicine | Issue 1/2020

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.

Trial registration

German Clinical Trials registry, DRKS00021675

WHO. Coronavirus disease (COVID-2019) situation reports 2020 [Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200607-COVID-19-sitrep-139.pdf?sfvrsn=79dc6d08_2.

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061–9.PubMedPubMedCentral

Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020;395(10223):514–23.PubMedPubMedCentral

Bajema KL, Oster AM, McGovern OL, Lindstrom S, Stenger MR, Anderson TC, et al. Persons evaluated for 2019 novel coronavirus - United States, January 2020. MMWR Morb Mortal Wkly Rep. 2020;69(6):166–70.PubMedPubMedCentral

Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239–42.PubMed

W-j G, Ni Z-y, Hu Y, Liang W-h, Ou C-q, He J-x, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708–20.

Wichmann D, Sperhake JP, Lütgehetmann M, et al. Autopsy findings and venous thromboembolism in patients with COVID-19. Ann Intern Med. 2020. p. M20-2003. https://doi.org/10.7326/M20-2003. [published online ahead of print, 2020 May 6].

Giacomelli A, Pezzati L, Conti F, et al. Self-reported olfactory and taste disorders in patients with severe acute respiratory coronavirus 2 infection: a cross-sectional study. Clin Infect Dis. 2020;71(15):889–90. https://doi.org/10.1093/cid/ciaa330.

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054–62.PubMedPubMedCentral

10.

Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):1–11. https://doi.org/10.1001/jamainternmed.2020.0994.

11.

Corman VM, Landt O, Kaiser M, Molenkamp R, Meijer A, Chu DK, et al. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Eurosurveillance. 2020;25(3):2000045.PubMedCentral

12.

Gao Y, Li T, Han M, et al. Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID-19. J Med Virol.2020;92(7):791–6. https://doi.org/10.1002/jmv.25770.

13.

Fan BE, Chong VCL, Chan SSW, Lim GH, Lim KGE, Tan GB, et al. Hematologic parameters in patients with COVID-19 infection. Am J Hematol. 2020;95(6):E131–E4.PubMed

14.

Mardani R, Ahmadi Vasmehjani A, Zali F, Gholami A, Mousavi Nasab SD, Kaghazian H, et al. Laboratory parameters in detection of COVID-19 patients with positive RT-PCR; a diagnostic accuracy study. Arch Acad Emerg Med. 2020;8(1):e43.PubMedPubMedCentral

15.

Lechien JR, Chiesa-Estomba CM, De Siati DR, et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of thecoronavirus disease (COVID-19): a multicenter European study. Eur Arch Otorhinolaryngol. 2020;277(8):2251–61. https://doi.org/10.1007/s00405-020-05965-1.

16.

Luers JC, Rokohl AC, Loreck N, Wawer Matos PA, Augustin M, Dewald F, Klein F, Lehmann C, Heindl LM. Olfactory and Gustatory Dysfunction in Coronavirus Disease 19 (COVID-19). Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, ciaa525. Advance online publication. 2020. https://doi.org/10.1093/cid/ciaa525.

17.

Mahmoodi BK, Matsushita K, Woodward M, Blankestijn PJ, Cirillo M, Ohkubo T, et al. Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without hypertension: a meta-analysis. Lancet. 2012;380(9854):1649–61.PubMedPubMedCentral

18.

Gao C, Cai Y, Zhang K, Zhou L, Zhang Y, Zhang X, et al. Association of hypertension and antihypertensive treatment with COVID-19 mortality: a retrospective observational study. Eur Heart J. 2020;41(22):2058–66.PubMed

19.

Park J-E, Jung S, Kim A, Park J-E. MERS transmission and risk factors: a systematic review. BMC Public Health. 2018;18(1):574.PubMedPubMedCentral

20.

Tonnesen P, Marott JL, Nordestgaard B, Bojesen SE, Lange P. Secular trends in smoking in relation to prevalent and incident smoking-related disease: A prospective population-based study. Tob Induc Dis. 2019;17:72.PubMedPubMedCentral

21.

Zhang JJ, Dong X, Cao YY, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020;75(7):1730–41.https://doi.org/10.1111/all.14238.

22.

Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet (London, England). 2020;395(10223):507–13.

23.

Korth J, Wilde B, Dolff S, Anastasiou OE, Krawczyk A, Jahn M, et al. SARS-CoV-2-specific antibody detection in healthcare workers in Germany with direct contact to COVID-19 patients. J Clin Virol. 2020;128:104437.PubMedPubMedCentral

24.

Ai T, Yang Z, Hou H, et al. Correlation of Chest CT and RT-PCR Testing for Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases.Radiology. 2020;296(2):E32–40. https://doi.org/10.1148/radiol.2020200642.

Title: Separating the wheat from the chaff—COVID-19 in a German emergency department: a case-control study
Authors: David Fistera
Dirk Pabst
Annalena Härtl
Benedikt Michael Schaarschmidt
Lale Umutlu
Sebastian Dolff
Carola Holzner
Clemens Kill
Joachim Risse
Publication date: 01-12-2020
Publisher: Springer Berlin Heidelberg
Keywords: Triage
SARS-CoV-2
COVID-19
Published in: International Journal of Emergency Medicine / Issue 1/2020
Print ISSN: 1865-1372
Electronic ISSN: 1865-1380
DOI: https://doi.org/10.1186/s12245-020-00302-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2020

Estimation of the burden of out-of-hospital traumatic cardiac arrest in Karachi, Pakistan, using a cross-sectional capture-recapture analysis

Urgent hyperbaric oxygen therapy for suicidal carbon monoxide poisoning: from a preliminary survey to a proposal for an integrated somatic-psychiatric protocol

Physical and mental health impacts of COVID-19 on healthcare workers: a scoping review

Intractable nausea and vomiting in naïve ingestion of kratom for analgesia

A qualitative study of workplace violence among healthcare providers in emergency departments in India

Manual ventilation quality is improved with a real-time visual feedback system during simulated resuscitation