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Characteristics and Unexpected COVID-19 Diagnoses in Resuscitation Room Patients during the COVID-19 Outbreak—A Retrospective Case Series
INTRODUCTION: Emergency department (ED) triage regarding infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is challenging. During the coronavirus disease 2019 (COVID-19) outbreak in Germany, the diagnostic outcomes of critically ill patients admitted to the resuscitation ro...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Hindawi
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7455815/ https://www.ncbi.nlm.nih.gov/pubmed/32884938 http://dx.doi.org/10.1155/2020/2721381 |
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author | Bergrath, Sebastian Aretz, Olaf Haake, Hendrik Ringelstein, Adrian Greiffendorf, Ingo Graeven, Ullrich Windfuhr, Jochen |
author_facet | Bergrath, Sebastian Aretz, Olaf Haake, Hendrik Ringelstein, Adrian Greiffendorf, Ingo Graeven, Ullrich Windfuhr, Jochen |
author_sort | Bergrath, Sebastian |
collection | PubMed |
description | INTRODUCTION: Emergency department (ED) triage regarding infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is challenging. During the coronavirus disease 2019 (COVID-19) outbreak in Germany, the diagnostic outcomes of critically ill patients admitted to the resuscitation room in the ED of our academic 754-bed hospital should be analyzed. METHODS: All resuscitation room patients between March 1st and April 15th 2020 were included in this retrospective study. Every patient with suspicion of SARS-CoV-2 infection received a pharyngeal swab for real-time polymerase chain reaction (rt-PCR), divided in the clinical subgroups of “highly suspicious for COVID-19” and “COVID-19 as differential diagnosis.” All respiratory and infectious symptoms were included as at least “differential diagnosis” as an expanded suspicion strategy. RESULTS: Ninety-five patients were included (trauma n = 14, critically ill n = 81). Of 3 highly suspicious patients, 2 had rt-PCR positive pharyngeal swabs. In 39 patients, COVID-19 was defined as differential diagnosis, and 3 were positive for SARS-CoV-2. Of them, pharyngeal swabs were positive in 1 case, while in 2 cases, only tracheal fluid was rt-PCR positive while the pharyngeal swabs were negative. In one of these 2 cases, chest computed tomography (CT) was also negative for ground-glass opacities but showed a pulmonary abscess and pulmonary embolism. CONCLUSION: We recommend an expanded suspicion strategy for COVID-19 due to unexpected diagnostic outcomes. Personal protective equipment should be used in every resuscitation room operation due to unexpected cases and initial knowledge gaps. Furthermore, tracheal fluid should be tested for SARS-CoV-2 in every intubated patient due to cases with negative pharyngeal swabs and negative chest CT. |
format | Online Article Text |
id | pubmed-7455815 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Hindawi |
record_format | MEDLINE/PubMed |
spelling | pubmed-74558152020-09-02 Characteristics and Unexpected COVID-19 Diagnoses in Resuscitation Room Patients during the COVID-19 Outbreak—A Retrospective Case Series Bergrath, Sebastian Aretz, Olaf Haake, Hendrik Ringelstein, Adrian Greiffendorf, Ingo Graeven, Ullrich Windfuhr, Jochen Biomed Res Int Clinical Study INTRODUCTION: Emergency department (ED) triage regarding infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is challenging. During the coronavirus disease 2019 (COVID-19) outbreak in Germany, the diagnostic outcomes of critically ill patients admitted to the resuscitation room in the ED of our academic 754-bed hospital should be analyzed. METHODS: All resuscitation room patients between March 1st and April 15th 2020 were included in this retrospective study. Every patient with suspicion of SARS-CoV-2 infection received a pharyngeal swab for real-time polymerase chain reaction (rt-PCR), divided in the clinical subgroups of “highly suspicious for COVID-19” and “COVID-19 as differential diagnosis.” All respiratory and infectious symptoms were included as at least “differential diagnosis” as an expanded suspicion strategy. RESULTS: Ninety-five patients were included (trauma n = 14, critically ill n = 81). Of 3 highly suspicious patients, 2 had rt-PCR positive pharyngeal swabs. In 39 patients, COVID-19 was defined as differential diagnosis, and 3 were positive for SARS-CoV-2. Of them, pharyngeal swabs were positive in 1 case, while in 2 cases, only tracheal fluid was rt-PCR positive while the pharyngeal swabs were negative. In one of these 2 cases, chest computed tomography (CT) was also negative for ground-glass opacities but showed a pulmonary abscess and pulmonary embolism. CONCLUSION: We recommend an expanded suspicion strategy for COVID-19 due to unexpected diagnostic outcomes. Personal protective equipment should be used in every resuscitation room operation due to unexpected cases and initial knowledge gaps. Furthermore, tracheal fluid should be tested for SARS-CoV-2 in every intubated patient due to cases with negative pharyngeal swabs and negative chest CT. Hindawi 2020-08-17 /pmc/articles/PMC7455815/ /pubmed/32884938 http://dx.doi.org/10.1155/2020/2721381 Text en Copyright © 2020 Sebastian Bergrath et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Clinical Study Bergrath, Sebastian Aretz, Olaf Haake, Hendrik Ringelstein, Adrian Greiffendorf, Ingo Graeven, Ullrich Windfuhr, Jochen Characteristics and Unexpected COVID-19 Diagnoses in Resuscitation Room Patients during the COVID-19 Outbreak—A Retrospective Case Series |
title | Characteristics and Unexpected COVID-19 Diagnoses in Resuscitation Room Patients during the COVID-19 Outbreak—A Retrospective Case Series |
title_full | Characteristics and Unexpected COVID-19 Diagnoses in Resuscitation Room Patients during the COVID-19 Outbreak—A Retrospective Case Series |
title_fullStr | Characteristics and Unexpected COVID-19 Diagnoses in Resuscitation Room Patients during the COVID-19 Outbreak—A Retrospective Case Series |
title_full_unstemmed | Characteristics and Unexpected COVID-19 Diagnoses in Resuscitation Room Patients during the COVID-19 Outbreak—A Retrospective Case Series |
title_short | Characteristics and Unexpected COVID-19 Diagnoses in Resuscitation Room Patients during the COVID-19 Outbreak—A Retrospective Case Series |
title_sort | characteristics and unexpected covid-19 diagnoses in resuscitation room patients during the covid-19 outbreak—a retrospective case series |
topic | Clinical Study |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7455815/ https://www.ncbi.nlm.nih.gov/pubmed/32884938 http://dx.doi.org/10.1155/2020/2721381 |
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