Evaluation of Covid-19 Triage Assessment Scale in Patients Attending the Emergency Department

Objective: To predict SARS-CoV-2 PCR positivity on the basis of symptoms and contact history of individuals who attend emergency department Methods: The data for the study which was of a prospective-methodological type were collected from 503 patients who attended emergency department of a hospital with suspected Covid-19 between 02 January - 15 March 2021 and were given Polymerase chain reaction (PCR) test. Covid 19 Visual Triage Scale (VTS) and questionnaire were used for collecting data. Distribution of socio-demographic data was interpreted in frequency, percentage. Independent samples t-test and chi-square test were used to compare quantitative data. Cut-off value of the scale was determined. In the study, sensitivity and specificity of the scale were tested through scoring adopted based on the real time PCR test result. Results: According to the PCR test, 67% of the patients were tested negative while 33% of them were positive. According to Covid-19 VTS, 55% of the patients were found to be negative while 45% were found positive. Validation of scale resulted in 0.65 AUC with a 45% sensitivity and 82% specificity using a cut-off value >4. In its comparison with PCR test, the scale was found to detect 93 real positive and 204 real negative patients. Self-reported fever, cough, sore throat, loss of taste and smell and history of contact with a confirmed Covid-19 case were found to be strong predictors for detecting Covid-19(p

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  • 1) Al-Sadeqa DW, Nasrallaha GK. The incidence of the novel coronavirus SARS-CoV-2 among asymptomatic patients: A systematic review. International Journal of Infectious Diseases, 2020; 98: 372–80. http://creativecommons.org/licenses/by-nc- nd/4.0/.
  • 2) 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 2020; 395: 507–13. https://doi.org/10.1016/S0140-6736(20)30211-7.
  • 3) Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 395: 507–13. https://doi.org/10.1056/NEJMoa2002032. 4) Republic of Turkey Ministry of Health, Covid 19 Information Page. General Coronavirus Table. Ankara 2020. Avaible at: https://covid19.saglik.gov.tr/TR-66935/genel-koronavirus-tablosu.html.
  • 5) Center for Disease Control (CDC). Covid 19, Emerging SARS-CoV-2 Variants. 2021. Avaible at: https://www.cdc.gov/coronavirus/2019-ncov/more/science-and-research/scientific-brief-emerging-variants.html 6) Kunt MM, Karaca MA. COVID 19 Pandemic and Emergency Service Triage. Anatolian Journal of Emergency Medicine 2020; 3(3): 96-8. (in Turkish).
  • 7) Center for Disease Control (CDC). Standard Operating Procedure (SOP) for Triage of Suspected COVID-19 Patients. Published online 2020:1-5. Avaible at: https://www.cdc.gov/coronavirus/2019- ncov/hcp/non-us-settings/sop-triage-prevent-transmission.html.
  • 8) Tokem Y, Turhan S, Uyur Celik G. Emergency Approach Strategies in COVID-19 Adult Patients with Definitive and Possible Diagnosis. Izmir Katip Celebi University Faculty of Health Sciences Journal, 2020; 5(2): 203-209. (in Turkish.
  • 9) 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: 514–23. https://doi.org/10.1016/S0140-6736(20)30154-9. 10) Cheng MP, Papenburg J, Desjardins M, Kanjilal S, Quach C, Libman M, et al. Diagnostic testing for severe acute respiratory syndrome-related coronavirus-2: a narrative review. Ann Intern Med 2020;172: 726–34. https://doi.org/10.7326/M20-1301.
  • 11) Peng QY, Wang XT, Zhang LN, Chinese Critical Care Ultrasound Study Group (CCUSG) (2020) Findings of lung ultrasonography of novel corona virus pneumonia during the 2019–2020 epidemic. Intensive Care Med. https://doi.org/10.1007/s0013 4-020-05996 -6.
  • 12) Açıksarı K, Kınık K. Process Management and Outcomes of the Emergency Department of a Training and Research Hospital in Turkey During the Coronavirus Disease 2019 Pandemic. Anatolian Clinic Journal of Medical Sciences, 2020; 25(Special Issue1): 263-83. https://doi.org/10.21673/anadoluklin.740776.
  • 13) Levenfus L, Ullmann E, Battegay E, Schuurmans MM. Triage tool for suspected COVID-19 patients in the emergency room: AIFELL score. braz j infect dis 2 0 2 0;2 4(5):458–461. https://doi.org/10.1016/j.bjid.2020.07.003. 14) Coskun S, Bebis H. Psychometric evaluation of a Turkish version of the e-health literacy scale (e-heals) in adolescent. Gulhane Med J 2015; 57: 378-84.
  • 15) Ozdamar, K. (2016). Structural equation modeling for scale and test development in education. (1st ed.). Eskişehir: Nisan Bookstore.
  • 16) Republic of Turkey Ministry of Health, Covid 19 General Information, Epidemiology and Diagnosis, 2020. Avaible at: https://hsgm.saglik.gov.tr/depo/covid19/Ingilizce/Rehber/COVID-19_Rehberi__Genel_bilgiler_epidemiyoloji_ve_tani_8.06.2020_eng.pdf.
  • 17) Kurstjens S, van der Horst A, Herpers R, Geerits MWL, Kluiters-de Hingh YCM, Göttgens E-L, et al. Rapid identification of SARS-CoV-2-infected patients at the emergency department using routine testing. Clin Chem Lab Med 2020; 58(9): 1587–93. https://doi.org/10.1515/cclm-2020-0593.
  • 18) Lippi G, Henry BM, Hoehn J, Benoit S, Benoit J. Validation of the Corona-Score for rapid identification of SARS-CoV-2 infections in patients seeking emergency department care in the United States. Clin Chem Lab Med 2020; 58(12): 311–3 https://doi.org/10.1515/cclm-2020-1121.
  • 19) Chou EH, Wang C, Hsieh Y, Namazi B, Wolfshohl J, Bhakta T, et al. Clinical Features of Emergency Department Patients from Early COVID-19 Pandemic that Predict SARS-CoV-2 Infection: Machine-learning Approach. West J Emerg Med. 2021; 22(2): 244-51. https://doi.org/10.5811/westjem.2020.12.49370.
  • 20) Joshi RP, Pejaver V, Hammarlund NE, Sung H, Lee SK, Furmanchuk A, et al A predictive tool for identification of SARS-CoV-2 PCR-negative emergency department patients using routine test results. Journal of Clinical Virology 129 (2020) 104502. https://doi.org/10.1016/j.jcv.2020.104502.
  • 21) Jamal AJ, Mozafarihashjin M, Coomes E, Powis J, Li AX, Paterson A, et al. Sensitivity of Nasopharyngeal Swabs and Saliva for the Detection of Severe Acute Respiratory Syndrome Coronavirus 2. Clinical Infectious Diseases 2020; XX(XX): 1–3. https://doi.org/10.1093/cid/ciaa848.
  • 22) Wang W, Xu Y, Gao R, Lu R, Han K, Wu G, et al. Detection of SARSCoV-2 in different types of clinical specimens. JAMA 2020; 12;323(18): 1843-4. https://doi.org/10.1001/jama.2020.3786.
  • 23) Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395(10223): 497-506. https://doi.org/10.1016/S0140-6736(20)30183-5.
  • 24) Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020; 395(10223): 507-13. https://doi.org/10.1016/S0140-6736(20)30211-7.
  • 25) Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020; 323(11): 1061-9. https://doi.org/10.1001/jama.2020.1585.
  • 26) O’reilly GM, Mitchell RD, Mitra B, Akhlaghi H, Tran V, Furyk JS, et al. Epidemiology and clinical features of emergency department patients with suspected and confirmed COVID-19: A multisite report from the COVID-19 Emergency Department Quality Improvement Project for July 2020 (COVED-3). Emergency Medicine Australasia (2021) 33, 114–124. https://doi.org/10.1111/1742-6723.13651.