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1.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-319106

ABSTRACT

Background: Purposefully designed and validated screening, triage, and severity scoring tools are needed to reduce mortality of COVID-19 in low-resource settings (LRS). This review aimed to identify currently proposed and/or implemented methods of screening, triaging, and severity scoring suspected COVID-19 patients upon initial presentation to the healthcare system, and to evaluate the utility of these tools in LRS. Methods: A scoping review was conducted to identify studies describing screening, triage, and severity scoring of suspected COVID-19 patients published between December 12, 2019 and September 01, 2020. Extracted information included clinical features, use of laboratory and imaging studies, and relevant tool validation data. Findings: The initial search strategy yielded 14,350 articles. A total of 93 manuscripts met inclusion criteria. Most studies were from China (n=37, 39.8%) or the United States (n=15, 16·1%). In total, 51 screening, 39 severity scoring tools, and 20 triage tools were described;13 of these – nine for screening, two for triage, and two for severity scoring – were identified as feasible in LRS and were being used in such settings. A total of 31 studies provided validation data: four prospective and 27 retrospective, with none from low-income and lower-middle-income countries. Interpretation: This study identified a wide range of screening, triage, and severity scoring tools implemented and proposed for suspected COVID-19 patients. No tools were designed and validated in LRS. A tool specific to resource limited context is crucial to reducing mortality in the current pandemic. Funding: No funding was received for this study.Declaration of Interests: The authors declare no competing interests.

2.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-319105

ABSTRACT

Background: In low-resource settings (LRS), a COVID-19 severity scoring tool could ensure timely access to appropriate care and guide use of critically limited resources. We systematically evaluated existing literature for associations between COVID-19 illness severity, and historical characteristics, clinical presentations, and investigations measurable in LRS. Methods: A systematic review of four databases from December 01, 2019 to June 01, 2020 identified all studies assessing potential associations between clinical characteristics and investigations, and illness severity. Data for all variables that were statistically analysed in relation to COVID-19 disease severity were extracted. A meta-analysis was conducted to generate pooled estimates of odds ratios (pORs). This review was registered with PROSPERO (CRD42020178098). Findings: Of 8402 relevant articles, 79 were eligible for inclusion, analysing 27713 patients with laboratory-confirmed COVID-19. A total of 202 features were analysed in relation to COVID-19 severity. Of these, 81 were deemed feasible for assessment in LRS: appropriate data were available for meta-analysis of 44 (54·3%). Meta-analysis identified 19 significant predictors of severe COVID-19, including: stroke (pOR: 3.08 (95% CI [1.95, 4.88])), shortness of breath (pOR: 2·78 (95% CI [2·24-3·46])), and chronic kidney disease (pOR: 2.55 (95% CI [1.52-4.29])). I 2 testing suggested substantial heterogeneity across samples. Interpretation: We identified multiple variables predictive of severe COVID-19. Due to the novelty of the disease, there is currently no prognostication tool purpose-designed and validated for LRS. Findings may inform such a tool that can offer guidance on clinical treatment and disposition, ultimately reducing morbidity and mortality due to the pandemic. Funding: No funding was received for this study.Declaration of Interests: The authors declare no competing interests.

3.
BMJ Open ; 11(9): e046130, 2021 09 15.
Article in English | MEDLINE | ID: covidwho-1412601

ABSTRACT

OBJECTIVES: Purposefully designed and validated screening, triage, and severity scoring tools are needed to reduce mortality of COVID-19 in low-resource settings (LRS). This review aimed to identify currently proposed and/or implemented methods of screening, triaging, and severity scoring of patients with suspected COVID-19 on initial presentation to the healthcare system and to evaluate the utility of these tools in LRS. DESIGN: A scoping review was conducted to identify studies describing acute screening, triage, and severity scoring of patients with suspected COVID-19 published between 12 December 2019 and 1 April 2021. Extracted information included clinical features, use of laboratory and imaging studies, and relevant tool validation data. PARTICIPANT: The initial search strategy yielded 15 232 articles; 124 met inclusion criteria. RESULTS: Most studies were from China (n=41, 33.1%) or the United States (n=23, 18.5%). In total, 57 screening, 23 triage, and 54 severity scoring tools were described. A total of 51 tools-31 screening, 5 triage, and 15 severity scoring-were identified as feasible for use in LRS. A total of 37 studies provided validation data: 4 prospective and 33 retrospective, with none from low-income and lower middle-income countries. CONCLUSIONS: This study identified a number of screening, triage, and severity scoring tools implemented and proposed for patients with suspected COVID-19. No tools were specifically designed and validated in LRS. Tools specific to resource limited contexts is crucial to reducing mortality in the current pandemic.


Subject(s)
COVID-19 , Triage , Humans , Prospective Studies , Retrospective Studies , SARS-CoV-2
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