ABSTRACT
OBJECTIVE: To explore the mechanisms and strategies for operation of fever clinics of a general hospital during prevention and control of COVID-19. METHODS: The working characteristics and management modes of the fever clinic of the First Medical Center of Chinese PLA General Hospital were analyzed and summarized during the period of normalized prevention and control without cases and the period with local outbreak. RESULTS: During the period of normalized prevention and control, strict pre-job admission was carried out, the new recruits must pass the qualification test for special positions, the daily training was intensified, the treatment procedures were optimized, the step of identification of infectious diseases was moved forward to the triage;the closed-loop management of information was improved, the links such as identification of infectious diseases, treatment warning, prewarning and reporting have been achieved, and the standard prevention measures were taken. During the period of local outbreak, the application for demand of personnel and prevention supplies was put forward, fever clinic was designed and expanded, supporting personnel was trained, shifts were reasonably arranged, supervisors were added, and 24-hour logistic shifts wee also added. Zero infection of health care workers and zero case of nosocomial infection were achieved during the prevention and control of epidemic. CONCLUSION: The fever clinic is an outpost of prevention and control of infectious diseases. Combined with the characteristics, it is recommended that the construction of departments, personnel management and hardware configuration should be solidified and promoted.
ABSTRACT
BACKGROUND: Currently, the need to prevent and control the spread of the 2019 novel coronavirus disease (COVID-19) outside of Hubei province in China and internationally has become increasingly critical. We developed and validated a diagnostic model that does not rely on computed tomography (CT) images to aid in the early identification of suspected COVID-19 pneumonia (S-COVID-19-P) patients admitted to adult fever clinics and made the validated model available via an online triage calculator. METHODS: Patients admitted from January 14 to February 26, 2020 with an epidemiological history of exposure to COVID-19 were included in the study [model development group (n=132) and validation group (n=32)]. Candidate features included clinical symptoms, routine laboratory tests, and other clinical information on admission. The features selection and model development were based on the least absolute shrinkage and selection operator (LASSO) regression. The primary outcome was the development and validation of a diagnostic aid model for the early identification of S-COVID-19-P on admission. RESULTS: The development cohort contained 26 cases of S-COVID-19-P and seven cases of confirmed COVID-19 pneumonia (C-COVID-19-P). The final selected features included one demographic variable, four vital signs, five routine blood values, seven clinical signs and symptoms, and one infection-related biomarker. The model's performance in the testing set and the validation group resulted in area under the receiver operating characteristic (ROC) curves (AUCs) of 0.841 and 0.938, F1 scores of 0.571 and 0.667, recall of 1.000 and 1.000, specificity of 0.727 and 0.778, and precision of 0.400 and 0.500, respectively. The top five most important features were age, interleukin-6 (IL-6), systolic blood pressure (SYS_BP), monocyte ratio (MONO%), and fever classification (FC). Based on this model, an optimized strategy for the early identification of S-COVID-19-P in fever clinics has also been designed. CONCLUSIONS: A machine-learning model based solely on clinical information and not on CT images was able to perform the early identification of S-COVID-19-P on admission in fever clinics with a 100% recall score. This high-performing and validated model has been deployed as an online triage tool, which is available at https://intensivecare.shinyapps.io/COVID19/.