Effect of a waiting room communication strategy on imaging rates and awareness of public health messages for low back pain in the emergency department

ObjectivesImaging for low back pain in the Emergency Department is common. We know that patients and public have misconceptions about value of imaging. Strong public health messaging to address misconceptions about imaging has the potential to reduce desire for imaging. The effects of waiting room communication strategy on use of diagnostic imaging of low back pain are not clear. We aimed determined the effect of a waiting room communication strategy to increase awareness of potential harms of unnecessary imaging for low back pain on lumbar imaging rates in the emergency department (ED).MethodWe conducted a controlled experimental study with BABA design, with a 6-week run-in time. This was followed by alternating one-week intervention and control periods. The Control group received standard waiting room messaging at the time (COVID-19 related messages), displayed on a 55’ LCD screen. The Intervention group received a communication strategy (five posters and an information leaflet) describing the potential harms of unnecessary imaging for low back pain, shown on the same screen. The primary outcome was the number and proportion of patients presenting to ED with low back pain who received at least one lumbar imaging test. Secondary patient-reported outcomes were patient satisfaction, and awareness of campaign messages.ResultsFor the imaging outcome, 337 people presenting to ED with low back pain were included over a 4-month period (intervention n= 99;control n= 238). Use of lumbar imaging was 25% in those exposed to the communication strategy (95% CI= 18% to 35%) compared with 29% in those exposed to the standard waiting room messaging (95% CI= 23% to 35%) (OR= 0.83;95% CI= 0.49 to 1.41). For the patient-reported outcomes, 349 patients presenting to ED for any condition responded to the survey (intervention n=170;control n=179;response rate =33%). There was uncertain evidence that the intervention increased awareness of the communication strategy Leaflet (OR= 2.00, 95% CI= 0.90 to 4.47). Other measures did not suggest between-group differences in patient satisfaction or awareness of the campaign messages.ConclusionsThe waiting room communication strategy may slightly reduce the proportion of patients with low back pain who receive lumbar imaging;though there is uncertainty due to imprecision. The campaign did not appear to increase awareness of campaign messages or affect patient satisfaction in a sample of patients presenting to the ED for any reason. Larger studies should investigate whether simple, low-cost waiting room communication strategies can raise awareness of unnecessary healthcare and influence healthcare quality.

Effective high-throughput RT-qPCR screening for SARS-CoV-2 infections in children (preprint)

Systematic SARS-CoV-2 testing is a valuable tool for infection control and surveillance. However, broad application of high sensitive RT-qPCR testing in children is often hampered due to unpleasant sample collection, limited RT-qPCR capacities, and high costs. Here, we developed a high-throughput approach (Lolli-Method) for sensitive SARS-CoV-2 detection in children, combining non-invasive sample collection with an RT-qPCR-pool testing strategy. SARS-CoV-2 infections were diagnosed with sensitivities of 100% and 93.9% when viral loads were >10E6 copies/ml and >10E3 copies/ml in corresponding Naso-/Oropharyngeal-swabs, respectively. For effective application of the Lolli-Method in schools and daycare facilities, SIR-modeling indicated a preferred frequency of two tests per week. The developed test strategy was implemented in 3,700 schools and 698 daycare facilities in Germany, screening over 800,000 individuals twice per week. In a period of 3 months, 6,364 pool-RT-qPCRs tested positive (0.64%) ranging from 0.05% to 2.61% per week. Notably, infections correlated with local SARS-CoV-2 incidences as well as with a school social deprivation index. Moreover, in comparison with the alpha variant, statistical modeling revealed a 31% increase for multiple (>1 child) infections per class following infections with the delta variant. We conclude that the Lolli-Method is a powerful tool for SARS-CoV-2 surveillance and infection control in schools and daycare facilities.

The performance of the SARS-CoV-2 RT-PCR test as a tool for detecting SARS-CoV-2 infection in the population. A survey of routine laboratory RT-PCR test results from the region of Muenster, Germany (preprint)

Objectives: To evaluate the population-based performance of the SARS-CoV-2 RT-PCR test as a tool for detecting SARS-CoV-2 infection during the pandemic in 2020. Methods: We analysed SARS-CoV-2 RT-PCR results of 162,457 people living in Muenster, Germany screened at nursing homes, testing sites, at schools, regional hospitals, and by general practitioners. All PCRs were done with the same cobas SARS-CoV-2 RT-PCR system (Roche Diagnostics). We stratified positive RT-PCR results by cycle threshold (Ct) values, periods of the national test strategy, age, sex, and symptoms. Results: Among 162,457 individuals, 4164 (2.6%) had a positive RT-PCR test result, defined as Ct<40. Depending on the national test strategy, higher positive rates were associated with testing predominantly symptomatic people. Children (0-9 years) and older adults (70+ years). Only 40.6% of test positives showed low Ct values < 25 (potentially infectious). The percentage of Ct values below 25 was lower among children (0-9), adolescents (10-19), and among the elderly (70+ years). Conclusions: RT-PCR testing as a tool for mass screening should not be used alone as a base for pandemic decision making including measures such as quarantine, isolation, and lockdown.