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Article

From the Triage to the Intermediate Area: A Simple and Fast Model for COVID-19 in the Emergency Department

by
Erika Poggiali
1,
Enrico Fabrizi
2,
Davide Bastoni
1,
Teresa Iannicelli
1,
Claudia Galluzzo
1,
Chiara Canini
1,
Maria Grazia Cillis
1,
Davide Giulio Ponzi
1,
Andrea Magnacavallo
1 and
Andrea Vercelli
1,*
1
Emergency Department, “Guglielmo da Saliceto” Hospital, 29121 Piacenza, Italy
2
DISES & DSS, Università Cattolica del Sacro Cuore, 29122 Piacenza, Italy
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2022, 19(13), 8070; https://doi.org/10.3390/ijerph19138070
Submission received: 3 June 2022 / Revised: 26 June 2022 / Accepted: 28 June 2022 / Published: 30 June 2022
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Abstract

Introduction: The early identification of patients with SARS-CoV-2 infection is still a real challenge for emergency departments (ED). First, we aimed to develop a score, based on the use of the lung ultrasonography (LUS), in addition to the pre-triage interview, to correctly address patients; second, we aimed to prove the usefulness of a three-path organization (COVID-19, not-COVID-19 and intermediate) compared to a two-path organization (COVID-19, non-COVID-19). Methods: We retrospectively analysed 292 patients admitted to our ED from 10 April to 15 April 2020, with a definite diagnosis of positivity (93 COVID-19 patients) or negativity (179 not-COVID-19 patients) for SARS-COV-2 infection. Using a logistic regression, we found a set of predictors for infection selected from the pre-triage interview items and the LUS findings, which contribute with a different weight to the final score. Then, we compared the organization of two different pathways. Results: The most informative factors for classifying the patient are known nasopharyngeal swab positivity, close contact with a COVID-19 patient, fever associated with respiratory symptoms, respiratory failure, anosmia or dysgeusia, and the ultrasound criteria of diffuse alveolar interstitial syndrome, absence of B-lines and presence of pleural effusion. Their sensitivity, specificity, accuracy, and AUC-ROC are, respectively, 0.83, 0.81, 0.82 and 0.81. The most significant difference between the two pathways is the percentage of not-COVID-19 patients assigned to the COVID-19 area, that is, 10.6% (19/179) in the three-path organization, and 18.9% (34/179) in the two-path organization (p = 0.037). Conclusions: Our study suggests the possibility to use a score based on the pre-triage interview and the LUS findings to correctly manage the patients admitted to the ED, and the importance of an intermediate area to limit the spread of SARS-CoV-2 in the ED and, as a consequence, in the hospital.
Keywords: COVID-19; SARS-CoV-2; lung ultrasound; emergency department; triage; score COVID-19; SARS-CoV-2; lung ultrasound; emergency department; triage; score

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MDPI and ACS Style

Poggiali, E.; Fabrizi, E.; Bastoni, D.; Iannicelli, T.; Galluzzo, C.; Canini, C.; Cillis, M.G.; Ponzi, D.G.; Magnacavallo, A.; Vercelli, A. From the Triage to the Intermediate Area: A Simple and Fast Model for COVID-19 in the Emergency Department. Int. J. Environ. Res. Public Health 2022, 19, 8070. https://doi.org/10.3390/ijerph19138070

AMA Style

Poggiali E, Fabrizi E, Bastoni D, Iannicelli T, Galluzzo C, Canini C, Cillis MG, Ponzi DG, Magnacavallo A, Vercelli A. From the Triage to the Intermediate Area: A Simple and Fast Model for COVID-19 in the Emergency Department. International Journal of Environmental Research and Public Health. 2022; 19(13):8070. https://doi.org/10.3390/ijerph19138070

Chicago/Turabian Style

Poggiali, Erika, Enrico Fabrizi, Davide Bastoni, Teresa Iannicelli, Claudia Galluzzo, Chiara Canini, Maria Grazia Cillis, Davide Giulio Ponzi, Andrea Magnacavallo, and Andrea Vercelli. 2022. "From the Triage to the Intermediate Area: A Simple and Fast Model for COVID-19 in the Emergency Department" International Journal of Environmental Research and Public Health 19, no. 13: 8070. https://doi.org/10.3390/ijerph19138070

APA Style

Poggiali, E., Fabrizi, E., Bastoni, D., Iannicelli, T., Galluzzo, C., Canini, C., Cillis, M. G., Ponzi, D. G., Magnacavallo, A., & Vercelli, A. (2022). From the Triage to the Intermediate Area: A Simple and Fast Model for COVID-19 in the Emergency Department. International Journal of Environmental Research and Public Health, 19(13), 8070. https://doi.org/10.3390/ijerph19138070

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