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Usefulness of PCR Screening in the Initial Triage of Trauma Patients During COVID-19 Pandemic.
Porcel-Vazquez, Juan A; Andres-Peiro, Jose V; Garcia-Sanchez, Yaiza; Guerra-Farfan, Ernesto; Mestre-Torres, Jaume; Minguell-Monyart, Joan; Molero-Garcia, Vicente; Selga Marsa, Jordi; Tomas-Hernandez, Jordi; Villar-Casares, Maria Del Mar; Bhandari, Mohit; Teixidor-Serra, Jordi.
  • Porcel-Vazquez JA; Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
  • Andres-Peiro JV; Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
  • Garcia-Sanchez Y; Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
  • Guerra-Farfan E; Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
  • Mestre-Torres J; Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain; and.
  • Minguell-Monyart J; Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
  • Molero-Garcia V; Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
  • Selga Marsa J; Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
  • Tomas-Hernandez J; Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
  • Villar-Casares MDM; Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain; and.
  • Bhandari M; Department of Surgery, McMaster University, Hamilton, ON, Canada.
  • Teixidor-Serra J; Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
J Orthop Trauma ; 34(10): e377-e381, 2020 10.
Article in English | MEDLINE | ID: covidwho-1243536
ABSTRACT

BACKGROUND:

Hospitals worldwide have postponed all nonessential surgery during the COVID-19 pandemic, but non-COVID-19 patients are still in urgent need of care. Uncertainty about a patient's COVID-19 status risks infecting health care workers and non-COVID-19 inpatients. We evaluated the use of quantitative reverse transcription polymerase chain reaction (RT-qPCR) screening for COVID-19 on admission for all patients with fractures.

METHODS:

We conducted a retrospective cohort study of patients older than 18 years admitted with low-energy fractures who were tested by RT-qPCR for SARS-CoV-2 at any time during hospitalization. Two periods based on the applied testing protocol were defined. During the first period, patients were only tested because of epidemiological criteria or clinical suspicion based on fever, respiratory symptoms, or radiological findings. In the second period, all patients admitted for fracture treatment were screened by RT-qPCR.

RESULTS:

We identified 15 patients in the first period and 42 in the second. In total, 9 (15.8%) patients without clinical or radiological findings tested positive at any moment. Five (33.3%) patients tested positive postoperatively in the first period and 3 (7.1%) in the second period (P = 0.02). For clinically unsuspected patients, postoperative positive detection went from 3 of 15 (20%) during the first period to 2 of 42 (4.8%) in the second (P = 0.11). Clinical symptoms demonstrated high specificity (92.1%) but poor sensitivity (52.6%) for infection detection.

CONCLUSIONS:

Symptom-based screening for COVID-19 has shown to be specific but not sensitive. Negative clinical symptoms do not rule out infection. Protocols and separated areas are necessary to treat infected patients. RT-qPCR testing on admission helps minimize the risk of nosocomial and occupational infection. LEVEL OF EVIDENCE Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Wounds and Injuries / RNA, Viral / Triage / Coronavirus Infections / Pandemics / Betacoronavirus Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: J Orthop Trauma Journal subject: Orthopedics / Traumatology Year: 2020 Document Type: Article Affiliation country: BOT.0000000000001903

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Wounds and Injuries / RNA, Viral / Triage / Coronavirus Infections / Pandemics / Betacoronavirus Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: J Orthop Trauma Journal subject: Orthopedics / Traumatology Year: 2020 Document Type: Article Affiliation country: BOT.0000000000001903