Changho Kim1, In Hwan Yeo2, Jong Kun Kim1, Yeonjoo Cho1, Mi Jin Lee1, Haewon Jung1, Jae Wan Cho1, Ji Yeon Ham3, Suk Hee Lee4, Han Sol Chung5, You Ho Mun5, Sang Hun Lee6, Yang Hun Kim7. 1. Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Korea. 2. Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Korea. inani1113@gmail.com. 3. Department of Laboratory Medicine, School of Medicine, Kyungpook National University, Daegu, Korea. 4. Department of Emergency Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea. 5. Department of Emergency Medicine, College of Medicine, Yeungnam University, Daegu, Korea. 6. Department of Emergency Medicine, Keimyung University Dongsan Hospital, Daegu, Korea. 7. Department of Emergency Medicine, Daegu Fatima Hospital, Daegu, Korea.
Abstract
BACKGROUND: There is currently a lack of evidence-based postresuscitation or postmortem guidelines for patients with out-of-hospital cardiac arrest (OHCA) in the setting of an emerging infectious disease. This study aimed to develop and validate a multimodal screening tool that aids in predicting the disease confirmation in emergency situations and patients with OHCA during a coronavirus disease 2019 (COVID-19) outbreak. MATERIALS AND METHODS: We conducted a retrospective, multicenter observational study of adult patients with OHCA in Daegu, Korea. To identify the potential predictors that could be used in screening tools in the emergency department, we applied logistic regression to data collected from March 1 to March 14. The prediction performance of the screening variables was then assessed and validated on the data of patients with OHCA who were treated between February 19 and March 31, 2020. General patient characteristics and hematological findings of the COVID-19-negative and COVID-19-positive groups were compared. We also evaluated confirmation test criteria as predictors for COVID-19 positivity in patients with OHCA. RESULTS: Advanced age, body temperature, and abnormal chest X-ray (CXR) revealed significant predictive ability in the derivation cohort. Of the 184 adult patients with OHCA identified in the validation cohort, 80 patients were included in the analysis. Notably, 9 patients were positive and 71 were negative on the COVID-19 reverse transcription polymerase chain reaction (RT-PCR) test. Five patients (55.6%) in the COVID-19-positive group had a fever before OHCA, and 12 (16.9%) of the COVID-19-negative group had a fever before OHCA (P = 0.018). Eight patients (88.9%) in the COVID-19-positive group had a CXR indicating pneumonic infiltration. Of the criteria for predicting COVID-19, fever or an abnormal CXR had a sensitivity of 100% (65.4 - 100) and a specificity of 22.5% (13.5 - 34.0). CONCLUSION: The screening tools that combined fever or abnormal CXR had a good discriminatory ability for COVID-19 infection in adult patients with OHCA. Therefore, during the COVID-19 outbreak period, it is recommended to suspect COVID-19 infection and perform COVID-19 test if patients present with a history of fever or show abnormal findings in postmortem CXR.
BACKGROUND: There is currently a lack of evidence-based postresuscitation or postmortem guidelines for patients with out-of-hospital cardiac arrest (OHCA) in the setting of an emerging infectious disease. This study aimed to develop and validate a multimodal screening tool that aids in predicting the disease confirmation in emergency situations and patients with OHCA during a coronavirus disease 2019 (COVID-19) outbreak. MATERIALS AND METHODS: We conducted a retrospective, multicenter observational study of adult patients with OHCA in Daegu, Korea. To identify the potential predictors that could be used in screening tools in the emergency department, we applied logistic regression to data collected from March 1 to March 14. The prediction performance of the screening variables was then assessed and validated on the data of patients with OHCA who were treated between February 19 and March 31, 2020. General patient characteristics and hematological findings of the COVID-19-negative and COVID-19-positive groups were compared. We also evaluated confirmation test criteria as predictors for COVID-19 positivity in patients with OHCA. RESULTS: Advanced age, body temperature, and abnormal chest X-ray (CXR) revealed significant predictive ability in the derivation cohort. Of the 184 adult patients with OHCA identified in the validation cohort, 80 patients were included in the analysis. Notably, 9 patients were positive and 71 were negative on the COVID-19 reverse transcription polymerase chain reaction (RT-PCR) test. Five patients (55.6%) in the COVID-19-positive group had a fever before OHCA, and 12 (16.9%) of the COVID-19-negative group had a fever before OHCA (P = 0.018). Eight patients (88.9%) in the COVID-19-positive group had a CXR indicating pneumonic infiltration. Of the criteria for predicting COVID-19, fever or an abnormal CXR had a sensitivity of 100% (65.4 - 100) and a specificity of 22.5% (13.5 - 34.0). CONCLUSION: The screening tools that combined fever or abnormal CXR had a good discriminatory ability for COVID-19infection in adult patients with OHCA. Therefore, during the COVID-19 outbreak period, it is recommended to suspect COVID-19infection and perform COVID-19 test if patients present with a history of fever or show abnormal findings in postmortem CXR.
Authors: Tommaso Scquizzato; Giovanni Landoni; Anna Mara Scandroglio; Annalisa Franco; Maria Grazia Calabrò; Andrea Paoli; Filippo D'Amico; Andrey Yavorovskiy; Alberto Zangrillo Journal: Eur J Emerg Med Date: 2021-12-01 Impact factor: 4.106