Evaluation of the Criteria Adopted to Identify Suspected Cases of COVID-19 in the Emergency Department Service of a Referral Palliative Oncology Care Unit

Am J Hosp Palliat Care. 2020 Sep 2;1049909120957310. doi: 10.1177/1049909120957310. Online ahead of print.

Abstract

Context: Due to the need for isolation of inpatients with suspected COVID-19, accuracy in identifying these cases in Emergency Department (ED) has great relevance, especially in Palliative Oncology Care Unit (PCU).

Objective: To evaluate the efficiency of clinical criteria adopted to identify suspected cases of COVID-19 by the ED in PCU.

Methods: All patients admitted to PCU between April and June 2020 from ED were included. The clinical criteria adopted to identify suspected COVID-19 cases were: being in contact with a suspected or confirmed case less than 14 days ago and / or presenting fever with no defined focus and / or respiratory symptoms not explained by oncological disease and / or suggestive image in radiological examination (if necessary). All suspected cases were submitted to deep nasal and throat swab for SARS COV-2 investigation by Reverse Transcription Polymerase Chain Reaction Test, adopted as gold standard. Inpatients hospitalized by ED, without suspicion, and then diagnosed with COVID-19 within 10 days of hospitalization were considered as false-negative cases.

Results: During the period, 327 patients were admitted from ED. Of these, 69 (21%) were considered suspects, of whom 34 (49%) tested positive for COVID-19. The sensitivity of the clinical criterion to identify suspected cases was 87%, specificity was 88%, positive predictive value was 49%, negative was 98% and accuracy was 88%.

Conclusion: The clinical criteria adopted to identify suspected cases of COVID-19 at ED proved to be efficient, with low risk of spreading in-hospital infection, avoiding unnecessary isolation of patients.

Keywords: COVID-19; cancer; clinical diagnosis; diagnosis; diagnostic techniques and procedures; palliative care.