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.

Multi-organ point-of-care ultrasound for detection of pulmonary embolism in critically ill COVID-19 patients - A diagnostic accuracy study.

PURPOSE: Critically ill COVID-19 patients have an increased risk of developing pulmonary embolism (PE). Diagnosis of PE by point-of-care ultrasound (POCUS) might reduce the need for computed tomography pulmonary angiography (CTPA), while decreasing time-to-diagnosis. MATERIALS & METHODS: This prospective, observational study included adult ICU patients with COVID-19. Multi-organ (lungs, deep vein, cardiac) POCUS was performed within 24 h of CTPA, looking for subpleural consolidations, deep venous thrombosis (DVT), and right ventricular strain (RVS). We reported the scan time, and calculated diagnostic accuracy measures for these signs separately and in combination. RESULTS: 70 consecutive patients were included. 23 patients (32.8%) had a PE. Median scan time was 14 min (IQR 11-17). Subpleural consolidations' diagnostic accuracy was: 42.9% (95%CI [34.1-52.0]). DVT's and RVS' diagnostic accuracy was: 75.6% (95%CI [67.1-82.9]) and 74.4% (95%CI [65.8-81.8]). Their sensitivity was: 24.0% (95%CI [9.4-45.1]), and 40.0% (95%CI [21.3-61.3]), while their specificity was: 88.8% (95%CI [80.8-94.3]), and: 83.0% (95%CI [74.2-89.8]), respectively. Multi-organ POCUS sensitivity was: 87.5% (95%CI [67.6-97.3]), and specificity was: 25% (95%CI [16.9-34.7]). CONCLUSIONS: Multi-organ rather than single-organ POCUS can be of aid in ruling out PE in critically ill COVID-19 and help select patients for CTPA. In addition, finding RVS can make PE more likely, while a DVT would preclude the need for a CTPA. REGISTRATION: www.trialregister.nl: NL8540.

Growth through adversity: The impact of COVID-19 pandemic on the american college of academic international medicine

The COVID-19 pandemic has been especially challenging to the academic international medical (AIM) community. The impact on the field of clinical medicine has been the most pronounced, particularly in the way that education is provided and academic medicine is pursued by clinicians. With the goal of providing top quality, highly relevant content for our membership, the American College of Academic International Medicine (ACAIM) teamed up with our sister organizations, the World Academic Congress of Emergency Medicine (WACEM), the Global Research on Acute conditions Team (GREAT, Rome, Italy and Basel, Switzerland), and EMA-INDIA (Indirapuram, India). The goal of this truly global coalition was to jointly host weekly web meetings that focus on topics relevant to participating stakeholder communities, with additional focus on the ongoing COVID-19 pandemic. Summary of these efforts and outcomes is provided in this article. The following core competencies are addressed in this article: Interpersonal and communication skills;Professionalism;Practice-based learning and improvement

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.

Growth through Adversity: The Impact of COVID-19 Pandemic on the American College of Academic International Medicine

The COVID-19 pandemic has been especially challenging to the academic international medical (AIM) community. The impact on the field of clinical medicine has been the most pronounced, particularly in the way that education is provided and academic medicine is pursued by clinicians. With the goal of providing top quality, highly relevant content for our membership, the American College of Academic International Medicine (ACAIM) teamed up with our sister organizations, the World Academic Congress of Emergency Medicine (WACEM), the Global Research on Acute conditions Team (GREAT, Rome, Italy and Basel, Switzerland), and EMA-INDIA (Indirapuram, India). The goal of this truly global coalition was to jointly host weekly web meetings that focus on topics relevant to participating stakeholder communities, with additional focus on the ongoing COVID-19 pandemic. Summary of these efforts and outcomes is provided in this article. © 2020 Wolters Kluwer Medknow Publications. All rights reserved.

Short Term Home Oxygen Therapy for COVID-19 patients: The COVID-HOT algorithm.

Innovative solutions are required to effectively address the unprecedented surge of demand on our healthcare systems created by the COVID-19 pandemic. Home treatment and monitoring of patients who are asymptomatic or mildly symptomatic can be readily implemented to ameliorate the health system burden while maintaining safety and effectiveness of care. Such endeavor requires careful triage and coordination, telemedicine and technology support, workforce and education, as well as robust infrastructure. In the understandable paucity of evidence-based, protocolized approaches toward HOT for COVID-19 patients, our group has created the current document based on the cumulative experience of members of the Joint ACAIM-WACEM COVID-19 Clinical Management Taskforce. Utilizing available evidence-based resources and extensive front-line experience, the authors have suggested a pragmatic pathway for providing safe and effective home oxygen therapy in the community setting.