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Characteristics and Unexpected COVID-19 Diagnoses in Resuscitation Room Patients during the COVID-19 Outbreak-A Retrospective Case Series.
Biomed Res Int. 2020; 2020:2721381.BR

Abstract

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.

Authors+Show Affiliations

Zentrum für klinische Akut-und Notfallmedizin, Kliniken Maria Hilf, Akademisches Lehrkrankenhaus der RWTH Aachen, Mönchengladbach, Germany. Lehrstuhl für Anästhesiologie, Medizinische Fakultät der RWTH, Aachen, Germany.Zentrum für klinische Akut-und Notfallmedizin, Kliniken Maria Hilf, Akademisches Lehrkrankenhaus der RWTH Aachen, Mönchengladbach, Germany.Klinik für Kardiologie und Internistische Intensivmedizin, Kliniken Maria Hilf, Akademisches Lehrkrankenhaus der RWTH Aachen, Mönchengladbach, Germany.Klinik für Radiologie und Neuroradiologie, Kliniken Maria Hilf, Akademisches Lehrkrankenhaus der RWTH Aachen, Mönchengladbach, Germany.Klinik für Hämatologie, Onkologie, Gastroenterologie und Infektiologie, Kliniken Maria Hilf, Akademisches Lehrkrankenhaus der RWTH Aachen, Mönchengladbach, Germany.Klinik für Hämatologie, Onkologie, Gastroenterologie und Infektiologie, Kliniken Maria Hilf, Akademisches Lehrkrankenhaus der RWTH Aachen, Mönchengladbach, Germany.Klinik für Hals-Nasen-Ohrenheilkunde, Kliniken Maria Hilf, Akademisches Lehrkrankenhaus der RWTH Aachen, Mönchengladbach, Germany.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

32884938

Citation

Bergrath, Sebastian, et al. "Characteristics and Unexpected COVID-19 Diagnoses in Resuscitation Room Patients During the COVID-19 Outbreak-A Retrospective Case Series." BioMed Research International, vol. 2020, 2020, p. 2721381.
Bergrath S, Aretz O, Haake H, et al. Characteristics and Unexpected COVID-19 Diagnoses in Resuscitation Room Patients during the COVID-19 Outbreak-A Retrospective Case Series. Biomed Res Int. 2020;2020:2721381.
Bergrath, S., Aretz, O., Haake, H., Ringelstein, A., Greiffendorf, I., Graeven, U., & Windfuhr, J. (2020). Characteristics and Unexpected COVID-19 Diagnoses in Resuscitation Room Patients during the COVID-19 Outbreak-A Retrospective Case Series. BioMed Research International, 2020, 2721381. https://doi.org/10.1155/2020/2721381
Bergrath S, et al. Characteristics and Unexpected COVID-19 Diagnoses in Resuscitation Room Patients During the COVID-19 Outbreak-A Retrospective Case Series. Biomed Res Int. 2020;2020:2721381. PubMed PMID: 32884938.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Characteristics and Unexpected COVID-19 Diagnoses in Resuscitation Room Patients during the COVID-19 Outbreak-A Retrospective Case Series. AU - Bergrath,Sebastian, AU - Aretz,Olaf, AU - Haake,Hendrik, AU - Ringelstein,Adrian, AU - Greiffendorf,Ingo, AU - Graeven,Ullrich, AU - Windfuhr,Jochen, Y1 - 2020/08/17/ PY - 2020/05/07/received PY - 2020/07/12/revised PY - 2020/07/30/accepted PY - 2020/9/5/entrez PY - 2020/9/5/pubmed PY - 2020/9/12/medline SP - 2721381 EP - 2721381 JF - BioMed research international JO - Biomed Res Int VL - 2020 N2 - 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. SN - 2314-6141 UR - https://www.unboundmedicine.com/medline/citation/32884938/Characteristics_and_Unexpected_COVID_19_Diagnoses_in_Resuscitation_Room_Patients_during_the_COVID_19_Outbreak_A_Retrospective_Case_Series_ L2 - https://doi.org/10.1155/2020/2721381 DB - PRIME DP - Unbound Medicine ER -