Role of ROX Index in the first assessment of COVID-19 patients in the Emergency Department (preprint)

Background: In Italy, since the first symptomatic cases of Coronavirus disease 2019 (COVID-19) appeared in late February 2020, 205.463 cases of Severe Acute Respiratory Syndrome 2 (SARS-CoV-2) were reported as of April 30, causing an high rate of hospital admission through the Emergency Department (ED).Objectives: The aim of the study was to evaluate the accuracy of ROX index in predicting hospitalization and mortality in patients with suspected diagnosis of COVID-19 in the ED. Secondary outcomes were to assess the number of readmissions and the variations of ROX index between first and second admission.Methods: This is an observational prospective monocentric study, conducted in the ED of Policlinico Sant’Orsola-Malpighi in Bologna. We enrolled 1371 consecutive patients with suspected COVID-19 and ROX index was calculated in 554 patients. Patients were followed until hospital discharge or death. Results: ROX index value < 25.7 was associated with hospitalization (AUC=0.737, 95%CI 0.696–0.779, p<0.001). ROX index < 22.3 is statistically related with higher 30-days mortality (AUC= 0.764, 95%CI 0.708-0.820, p<0.001). 8 patients were discharged and returned in the ED within the following 7 days, their mean ROX index was 30.3 (6.2; range 21.9-39.4) at the first assessment and 24.6 (5.5; 14.5-29.5) at the second assessment, (p=0.012).Conclusion: ROX index, together with laboratory, imaging and clinical findings, can help discriminate patients suspected for COVID-19 requiring hospital admission, their clinical severity and their mortality risk. Furthermore, it can be useful to better manage these patients in territorial healthcare services, especially in the hypothesis of another pandemic.

Alveolar-to-arterial oxygen gradient: role in the management of COVID-19 infection mild population (preprint)

COVID-19 infection is frequently associated with radiological diagnosis of interstitial pneumonia and alteration in gases exchange. We decided to test arterial blood gas assay parameters, in particular alveolar-to-arterial oxygen gradient (AaDO2), in predicting the need of hospitalization, the survival rate and in identifying pneumonia in patients with SARS-CoV-2 infection.We conducted an observational prospective study in one of the Emergency Department of our city. We included consecutive patients with symptoms likely related to SARS-CoV-2 infection, confirmed either with positive nasal pharyngeal swabs and/or with suggestive radiological findings. Areas under the curve of the receiver operator characteristic curve were computed to predict need of hospitalization and the presence of pneumonia. Survival curves were analyzed using a Log-rank test. P-value less than 0.05 were considered statistically significant.We enrolled 825 patients; the final population was composed by 530 patients. Most of them were hospitalized due to complications, the mortality was 14% but no death occured in the ED. It results that a threshold for AaDO2 of 27 could predict the need of hospitalization as well as a threshold for AaDO2 of 24 could identify the presence of pneumonia. Survival curves revealed that patients with a value of AaDO2 less than or equal to 40 had a better survival. We suggest the application of ABG parameters, in particular AaDO2, during the first assessment of COVID-19 patients in the ED, because they could be additional tools to help the emergency physician to evaluate the clinical severity of patients.The study was approved by our local ethics committee with the number 551/2020/Oss/AOUBo.

Management reorganization of a Radiology ward during the Covid-19 pandemic in a University Hospital structured inpavilions. (preprint)

Objective: The aim of the recent management reorganization of the Emergency Room and Radiology ward was to face the recent Coronavirus pandemic in the most rational way possible, to preserve the essential role of these Units in the complex context of a pavillions structured Hospital. Methods: The most challenging management criticalities posed by the recent Coronavirus pandemic were individually analyzed and dealt with. The pavilions structure of our Hospital, biohazard management, shortage of personnel and shortage or temporary inadequacy of personal protective equipment were addressed as the most urgent and important problems.Results: A strategic use of the Radiology Information System and Picture Archiving And Communication System (RIS-PACS), dedicated ambulances with specific disinfection procedures, the institution of dedicated pavilions, wards, checkpoints and different paths for COVID-19 (Coronavirs Disease 2019) and non COVID-19 patients, frequent sanification procedures, serological screening for employees and emergency dedicated staff recruitment were put to place as a result of said analysis.Nevertheless, all of these goals couldn’t have been achieved without a constant sense of responsibility of the employees involved.Conclusions: A rational analysis of the most critical problems associated with a pandemic is vital to provide a fast and effective response, and represents a valuable wealth of experience in case of future pandemics.