• Medicina clinica · May 2022

    Radiography-based triage for COVID-19 in the Emergency Department in a Spanish cohort of patients.

    • Abiu Sempere-González, Jordi Llaneras-Artigues, Iago Pinal-Fernández, Esperanza Cañas-Ruano, Olimpia Orozco-Gálvez, Eva Domingo-Baldrich, Xabier Michelena, Beatriz Meza, Eloi García-Vives, Albert Gil-Vila, Javier Sarrapio-Lorenzo, Sheila Romero-Ruperto, Francesc Sanpedro-Jiménez, María Arranz-Betegón, and Andreu Fernández-Codina.
    • Emergency Department, University Hospital Vall d'Hebron, Barcelona, Spain.
    • Med Clin (Barc). 2022 May 27; 158 (10): 466471466-471.

    BackgroundStrategies to determine who could be safely discharged home from the Emergency Department (ED) in COVID-19 are needed to decongestion healthcare systems.ObjectivesTo describe the outcomes of an ED triage system for non-severe patients with suspected COVID-19 and possible pneumonia based on chest X-ray (CXR) upon admission.Material And MethodsRetrospective, single-center study performed in Barcelona (Spain) during the COVID-19 peak in March-April 2020. Patients with COVID-19 symptoms and potential pneumonia, without respiratory insufficiency, with priority class IV-V (Andorran triage model) had a CXR upon admission. This approach tried to optimize resource use and to facilitate discharges. The results after adopting this organizational approach are reported.ResultsWe included 834 patients, 53% were female. Most patients were white (66%) or Hispanic (27%). CXR showed pneumonia in 523 (62.7%). Compared to those without pneumonia, patients with pneumonia were older (55 vs 46.6 years old) and had a higher Charlson comorbidity index (1.9 vs 1.3). Patients with pneumonia were at a higher risk for a combined outcome of admission and/or death (91 vs 12%). Death rates tended to be numerically higher in the pneumonia group (10 vs 1). Among patients without pneumonia in the initial CXR, 10% reconsulted (40% of them with new pneumonia).ConclusionCXR identified pneumonia in a significant number of patients. Those without pneumonia were mostly discharged. Mortality among patients with an initially negative CXR was low. CXR triage for pneumonia in non-severe COVID-19 patients in the ED can be an effective strategy to optimize resource use.Copyright © 2021 Elsevier España, S.L.U. All rights reserved.

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