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Boldt KL, Bolanaki M, Holert F, Fischer-Rosinský A, Slagman A, Möckel M. Effects of Different SARS-CoV-2 Testing Strategies in the Emergency Department on Length of Stay and Clinical Outcomes: A Randomised Controlled Trial. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2024; 2024:9571236. [PMID: 38384429 PMCID: PMC10881249 DOI: 10.1155/2024/9571236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/19/2023] [Accepted: 01/24/2024] [Indexed: 02/23/2024]
Abstract
The turn-around-time (TAT) of diagnostic and screening measures such as testing for SARS-CoV-2 can affect a patient's length of stay (LOS) in the hospital as well as the emergency department (ED). This, in turn, can affect clinical outcomes. Therefore, a reliable and time-efficient SARS-CoV-2 testing strategy is necessary, especially in the ED. In this randomised controlled trial, n = 598 ED patients presenting to one of three university hospital EDs in Berlin, Germany, and needing hospitalisation were randomly assigned to two intervention groups and one control group. Accordingly, different SARS-CoV-2 testing strategies were implemented: rapid antigen and point-of-care (POC) reverse transcription polymerase chain reaction (rtPCR) testing with the Roche cobas® Liat® (LIAT) (group one n = 198), POC rtPCR testing with the LIAT (group two n = 197), and central laboratory rtPCR testing (group three, control group n = 203). The median LOS in the hospital as an inpatient across the groups was 7 days. Patients' LOS in the ED of more than seven hours did not differ significantly, and furthermore, no significant differences were observed regarding clinical outcomes such as intensive care unit stay or death. The rapid and POC test strategies had a significantly (p < 0.01) shorter median TAT (group one 00:48 h, group two 00:21 h) than the regular central laboratory rtPCR test (group three 06:26 h). However, fast SARS-CoV-2 testing strategies did not reduce ED or inpatient LOS significantly in less urgent ED admissions. Testing strategies should be adjusted to the current circumstances including crowding, SARS-CoV-2 incidences, and patient cohort. This trial is registered with DRKS00023117.
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Affiliation(s)
| | | | | | | | - Anna Slagman
- Charité-Universitätsmedizin Berlin, Berlin, Germany
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Sangal RB, Peaper DR, Rothenberg C, Landry ML, Sussman LS, Martinello RA, Ulrich A, Venkatesh AK. Universal SARS-CoV-2 Testing of Emergency Department Admissions Increases Emergency Department Length of Stay. Ann Emerg Med 2021; 79:182-186. [PMID: 34756452 PMCID: PMC8424016 DOI: 10.1016/j.annemergmed.2021.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/20/2021] [Accepted: 09/01/2021] [Indexed: 11/17/2022]
Abstract
Study objective Our institution experienced a change in SARS-CoV-2 testing policy as well as substantial changes in local COVID-19 prevalence, allowing for a unique examination of the relationship between SARS-CoV-2 testing and emergency department (ED) length of stay. Methods This was an observational interrupted time series of all patients admitted to an academic health system between March 15, 2020, and September 30, 2020. Given testing limitations from March 15 to April 24, all patients receiving SARS-CoV-2 tests were symptomatic. On April 24, testing was expanded to all ED admissions. The primary and secondary outcomes were ED length of stay and number needed to test to obtain a positive, respectively. Results A total of 70,856 patients were cared for in the EDs during the 7-month period. The testing change increased admission length of stay by 1.89 hours (95% confidence interval 1.39 to 2.38). The number needed to test was 2.5 patients and was highest yield on April 1, 2020, when the state positivity rate was 39.7%; however, the number needed to test exceeded 170 patients by Sept 1, 2020, at which point the state positivity rate was 0.5%. Conclusion Although universal SARS-CoV-2 testing of ED admissions may meaningfully support mitigation and containment efforts, the clinical cost of testing all admissions amid low community positivity is notable. In our system, universal ED SARS-CoV-2 testing was associated with a 24% increase in admission length of stay alongside the detection of only 1 positive case every other day. Given the known harms and risks of ED boarding and crowding, solutions must be developed to support regular operational flow while balancing infection prevention needs.
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Affiliation(s)
- Rohit B Sangal
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT.
| | - David R Peaper
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT
| | - Craig Rothenberg
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Marie L Landry
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT; Department of Medicine, Yale University School of Medicine, New Haven, CT; Clinical Virology Laboratory, Yale New Haven Hospital, New Haven, CT
| | - L Scott Sussman
- Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - Richard A Martinello
- Department of Medicine, Yale University School of Medicine, New Haven, CT; Department of Pediatrics, Yale University School of Medicine, New Haven, CT; Department of Infection Prevention, Yale New Haven Health, New Haven, CT
| | - Andrew Ulrich
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
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O’Kelly B, Cronin C, Connellan D, Griffin S, Connolly SP, McGrath J, Cotter AG, McGinty T, Muldoon EG, Sheehan G, Cullen W, Doran P, McHugh T, Vidal L, Avramovic G, Lambert JS. Antibiotic prescribing patterns in patients hospitalized with COVID-19: lessons from the first wave. JAC Antimicrob Resist 2021; 3:dlab085. [PMID: 34223144 PMCID: PMC8242139 DOI: 10.1093/jacamr/dlab085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/25/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND A high proportion of hospitalized patients with COVID-19 receive antibiotics despite evidence to show low levels of true bacterial coinfection. METHODS A retrospective cohort study examining antibiotic prescribing patterns of 300 patients sequentially diagnosed with COVID-19. Patients were grouped into 3 sub-cohorts: Group 1 received no antibiotics, Group 2 received antibiotics for microbiologically confirmed infections and Group 3 was empirically treated with antibiotics for pneumonia. The primary aim was to identify factors that influenced prescription and continuation of antibiotics in Group 3. Secondary aims were to examine differences in outcomes between groups. RESULTS In total, 292 patients were included (63 Group 1, 35 Group 2, 194 Group 3), median age was 60 years (IQR 44-76) and the majority were ethnically Irish (62%). The median duration of antibiotics was 7 days (IQR 5-10). In Group 3, factors associated with prescription IV antibiotics on admission were raised C-reactive protein (CRP) (P = 0.024), increased age (P = 0.023), higher quick SOFA (P = 0.016) score and fever >37.5 °C (P = 0.011). Factors associated with duration of antibiotic course were duration of hypoxia (P < 0.001) and maximum respiratory support requirement (P = 0.013). Twenty-one patients in Group 3 had one or more antibiotic escalation events, most (n = 139) had no escalation or de-escalation of therapy. CONCLUSIONS Duration of hypoxia and need for respiratory support may have acted as surrogate measures of improvement where usual response measures (CRP, neutrophilia, culture clearance) were absent. Continuous review of antibiotic prescriptions should be at the forefront of clinical management of hospitalized patients with COVID-19.
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Affiliation(s)
- Brendan O’Kelly
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin 4, Ireland
| | - Colm Cronin
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - David Connellan
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Sean Griffin
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Stephen Peter Connolly
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin 4, Ireland
| | - Jonathan McGrath
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Aoife G Cotter
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin 4, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Tara McGinty
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin 4, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Eavan G Muldoon
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Gerard Sheehan
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Walter Cullen
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Peter Doran
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Tina McHugh
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Louise Vidal
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | | | - John S Lambert
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
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