Screening for asymptomatic deep vein thrombosis in COVID-19 patients admitted to the medical ward: a cross-sectional study.

PURPOSE: Patients with COVID-19 have an increased risk for venous thrombo-embolism (VTE), especially pulmonary embolism. The exact prevalence of asymptomatic DVT is not known, as is the usefulness of screening for DVT in patients admitted to ward with COVID-19. We have studied the prevalence of asymptomatic DVT. METHODS: We performed a cross-sectional observational multi-center study at four university medical centers in The Netherlands. All adult patients admitted with COVID-19 to a medical ward were eligible for inclusion, including patients who were transferred back from the ICU to the ward. The study protocol consisted of weekly cross-sectional rounds of compression ultrasound. RESULTS: In total, 125 patients were included in the study. A significant proportion of patients (N = 34 (27%)) had developed a VTE during their admission for COVID-19 before the study ultrasound was performed. In most VTE cases (N = 27 (79%)) this concerned pulmonary embolism. A new asymptomatic DVT was found in 5 of 125 patients (4.0%; 95% CI 1.3-9.1%) (Table 2). Nine patients (7.2%; 95% CI 3.3-13.2%) developed a VTE (all PE) diagnosed within 28 days after the screening US was performed. CONCLUSION: We have shown a low prevalence (4%) of newly discovered asymptomatic DVT outside the ICU-setting in COVID-19 patients. Despite this low prevalence, nine patients developed PE (7%) within 28 days after ultrasound. This favors the hypothesis of local thrombus formation in the lungs. Based on our findings and literature, we do not recommend US-screening of asymptomatic patients with COVID-19 admitted to the ward.

Incidence of Sars-COV-2 Infection in Sickle Cell Patients Presenting with a Painful Crisis, a 12 Month Prospective Cohort Study

Background: Sickle cell disease (SCD) is frequently complicated by painful vaso-occlusive crises (VOCs) often resulting in healthcare utilization including hospital admission. A vaso-occlusive crisis (VOC) can be induced by multiple factors including infection, exposure to cold, physical exercise, dehydration and stress. Given the current SARS-CoV-2 pandemic, we hypothesized that SARS-CoV-2 (even without symptoms of upper airway infection) might play a major causal role in VOC. However, our data suggests that COVID-19 is not a frequent provoking factor for clinical VOCs during the pandemic. Methods: In order to test this hypothesis, consecutive SCD patients presenting to the emergency department in our centre with symptoms compatible with VOC between March 16 th 2020 and March 16 th 2021, were tested for SARS-CoV-2 by real-time polymerase chain reaction (RT-PCR) of nasopharyngeal swabs irrespective of respiratory symptoms. Given the limited sensitivity of the RT-PCR in SARS-CoV-2 high incidence groups, low-dose non-contrast chest CT-scans were initially performed in addition to the RT-PCR.In addition, data comprised of temperature, oxygen saturation and laboratory results, was collected through chart review, from the visit at the emergency department. Presentations of SCD patients with a proven prior SARS-CoV-2 infection were excluded. Results: In total 122 VOCs in 70 adult SCD patients, presenting to the emergency department between March 16 th 2020 and March 16 th 2021, were evaluated. (Figure 1) Five presentations in two individual patients were excluded due to a prior RT-PCR proven SARS-CoV-2 infection. Furthermore, 13 presentations in six patients were excluded due to non-protocol adherence (not obtaining a RT-PCR at presentation). In total 104 episodes of VOC in 62 patients with SCD were prospectively analyzed on SARS-CoV-2 by RT-PCR irrespective of respiratory symptoms. In 104 consecutive presentations, five presentations tested positive on SARS-CoV-2 (4.8%). Only one of these five patients presented with respiratory symptoms in addition to the symptoms of a VOC and one patient was diagnosed with acute chest syndrome (ACS). Five of the 99 presentations of patients with a negative SARS-CoV-2 PCR, presented with respiratory symptoms. In this group, seven patients developed an ACS during admission. From March 16 th till May 31 st 2020, routine CT-scans were performed, in 23 out of 27 presentations with a VOC at the emergency department in addition to the RT-PCR in order to increase the diagnostic accuracy. In 19 of these presentations, that were tested negative for SARS-COV-2, no CT-abnormalities suggestive for COVID-19 were found. One of four CT-scans performed in patients with a positive RT-PCR, showed abnormalities that were not specific for COVID-19. Conclusion: In conclusion, we found a low incidence of SARS-CoV-2 infections in our cohort of consecutive SCD patients presenting with VOCs in 12 months during the COVID-19 pandemic. This suggests that COVID-19 is not a frequent provoking factor for clinical VOCs during the pandemic and may even be considered a coincidental finding given the low incidence and the fact that only one of the five patients with a positive RT-PCR presented with pulmonary symptoms. [Formula presented] Disclosures: Nur: Celgene: Speakers Bureau;Roche: Speakers Bureau;Novartis: Research Funding, Speakers Bureau.

Predicting poor outcome in patients with suspected COVID-19 presenting to the Emergency Department (COVERED) - Development, internal and external validation of a prediction model

BACKGROUND: A recent systematic review recommends against the use of any of the current COVID-19 prediction models in clinical practice. To enable clinicians to appropriately profile and treat suspected COVID-19 patients at the emergency department (ED), externally validated models that predict poor outcome are desperately needed. OBJECTIVE: Our aims were to identify predictors of poor outcome, defined as mortality or ICU admission within 30 days, in patients presenting to the ED with a clinical suspicion of COVID-19, and to develop and externally validate a prediction model for poor outcome. METHODS: In this prospective, multi-center study, we enrolled suspected COVID-19 patients presenting at the EDs of two hospitals in the Netherlands. We used backward logistic regression to develop a prediction model. We used the area under the curve (AUC), Brier score and pseudo-R2 to assess model performance. The model was externally validated in an Italian cohort. RESULTS: We included 1193 patients between March 12 and May 27 2020, of whom 196 (16.4%) had a poor outcome. We identified 10 predictors of poor outcome: current malignancy (OR 2.774;95%CI 1.682-4.576), systolic blood pressure (OR 0.981;95%CI 0.964-0.998), heart rate (OR 1.001;95%CI 0.97-1.028), respiratory rate (OR 1.078;95%CI 1.046-1.111), oxygen saturation (OR 0.899;95%CI 0.850-0.952), body temperature (OR 0.505;95%CI 0.359-0.710), serum urea (OR 1.404;95%CI 1.198-1.645), C-reactive protein (OR 1.013;95%CI 1.001-1.024), lactate dehydrogenase (OR 1.007;95%CI 1.002-1.013) and SARS-CoV-2 PCR result (OR 2.456;95%CI 1.526-3.953). The AUC was 0.86 (95%CI 0.83-0.89), with a Brier score of 0.32 and, and R2 of 0.41. The AUC in the external validation in 500 patients was 0.70 (95%CI 0.65-0.75). CONCLUSION: The COVERED risk score showed excellent discriminatory ability, also in an external validation. It may aid clinical decision making, and improve triage at the ED in health care environments with high patient throughputs.