Impact of the COVID-19 pandemic on visits to the hospital emergency service in two hospitals in Spain, from March 14, 2020 to June 21, 2020.

This study will describe trends in the use of emergency departments before and after the Spanish State of Alarm, especially in pathologies not directly related to this infection. A cross-sectional study was conducted of all visits to the emergency departments in two third-level hospitals in two Spanish communities during the Spanish State of Alarm, compared with the same period of the previous year. The variables collected included the day of the week, the time of the visit, the duration of the visit, the final destination of the patients (home, admission to a conventional hospitalization ward, admission to the intensive care unit, and death), and the diagnosis at discharge according to the International Classification of Diseases 10th Revision. During the Spanish State of Alarm period, an overall decrease in care demand of 48% was observed, which reached 69.5% in pediatric emergency departments. We also saw a drop of between 20 and 30% in time-dependent pathologies (heart attack, stroke, sepsis, poisoning). The decrease in overall attendance in the emergency departments and absence of serious pathologies, such as time-dependent diseases, observed during the Spanish State of Alarm compared to the previous year highlights the need to strengthen the messages addressed to the population to encourage them to seek care without delay in case of alarming symptoms and reduce the high morbidity and mortality rate if the diagnosis is delayed.

The National Early Warning Score on admission predicts severe disease and in-hospital mortality of the coronavirus disease 2019 Delta variant: A retrospective cohort study.

Background: Clinical risk scores are widely used in emergency medicine, and some studies have evaluated their use in patients with coronavirus disease 2019 (COVID-19). However, no studies have evaluated their use in patients with the COVID-19 Delta variant. We aimed to study the performance of four different clinical scores (National Early Warning Score [NEWS], quick Sequential Organ Failure Assessment [qSOFA], Confusion, Respiratory rate, Blood pressure, and Age ≥65 [CRB-65], and Kanagawa score) in predicting the risk of severe disease (defined as the need for intubation and in-hospital mortality) in patients with the COVID-19 Delta variant. Methods: This was a retrospective cohort study of patients hospitalized with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant infection between June 1 and December 31, 2021. The primary outcomes were the sensitivity and specificity of the aforementioned clinical risk scores at admission to predict severe disease. Areas under the receiver operating characteristic curves (AUROCs) were compared between the clinical risk scores and we identified new cut-off points for all four scores. Results: A total of 249 adult patients were included, of whom 18 developed severe disease. A NEWS ≥7 at admission predicted severe disease with 72.2% sensitivity and 86.2% specificity. The NEWS (AUROC 0.88) was superior to both the qSOFA (AUROC 0.74) and the CRB-65 (AUROC 0.67), and there was no significant difference between the NEWS and Kanagawa score (AUROC 0.86). Conclusion: The NEWS at hospital admission predicted the severity of the COVID-19 Delta variant with high accuracy.

Using a manifold-based approach to extract clinical codes associated with winter respiratory viruses at an emergency department

Every winter, respiratory viruses put most Emergency Departments (ED) around the world under intense pressure. To reduce the consequent stress for hospitals, anticipation of the massive increase of intakes for illness-based symptoms is essential. As the Covid-19 2020 pandemic clearly illustrates, patients are not systematically tested. The ED staff therefore has no real-time knowledge of the presence of the virus in the patients flow. To address this issue, we propose here to use the hospital's laboratory-confirmed database as an attractor for the manifold-based approach for clustering the clinical codes associated with respiratory viruses. We propose a new framework based on the embedding of time series onto the Stiefel manifold, coupled with a density-based clustering algorithm (HDBSCAN) enhanced by a reduction of dimension (UMAP) for the clustering on that manifold. In particular, we show, based on real data sets of two academic hospitals in France, the significant benefits of using geometrical approaches for time series clustering as compared to traditional methods.

Assessment, diagnosis and treatment of children who present with stridor.

The presence of stridor in children signifies a partial obstruction in the upper airways, the cause of which may range from mild to life-threatening depending on aetiology. The most common causes of stridor in this population are laryngotracheobronchitis (viral croup) and foreign body aspiration. This article gives an overview of the signs, symptoms and potential causes of stridor and the signs and symptoms of, and diagnostic criteria for, viral croup. The author also discusses evidence-based assessment criteria and treatments and criteria for admission or discharge. A case study is used for illustration.

Managing the end of life in COVID patients. The role of palliative care in emergency departments during the pandemic.

Managing COVID-19 patients has been an extremely difficult and dramatic task, especially for emergency departments during the strongest waves of the pandemic in Italy. Medical staff and health professionals were redeployed from their work setting to COVID units; many were overwhelmed by the deaths of so many patients in a very short time. This work aimed to explore palliative care health professionals' and physicians' perceptions of end-of-life care management in COVID units during the first two waves of the pandemic in Italy. Qualitative data was collected through 24 semi-structured in-depth interviews. The participants were palliative care medical and health professionals redeployed, or in a supporting role, COVID units from the most affected areas of northern and central Italy. The interview questions were focused on four thematic areas concerning different aspects of the role and responsibilities of the palliative care specialist (physician and healthcare professional). A brief presentation of the main sociological literature on end-of-life management in hospital contexts will be firstly presented and discussed to offer a theoretical frame. Subsequently, some of the most significant results that emerged from our research will be illustrated concerning the role played by palliative care professionals during the pandemic and the relevance of the palliative care approach in emergency contexts.

Factors Affecting the Length of Stay in the Emergency Department in Psychiatric Emergency Patients in the COVID-19 Pandemic Context.

To reduce overcrowding in emergency departments (ED), which is a serious international problem, it is important to reduce the length of ED stay (ED LOS) of emergency patients. In particular, due to the COVID 19 pandemic, psychiatric emergency patients spent much longer in ED. This study was conducted to identify the characteristics of psychiatric emergency patients who visited the ED during the COVID-19 pandemic and to identify factors affecting ED LOS. This retrospective study was conducted on adult patients aged 19 years or older who visited a psychiatric emergency center operated by an ED from 1 May 2020 to 31 April 2021 because of the COVID-19 pandemic. In this study, the average ED LOS of psychiatric emergency patients was 7.8 h. Factors affecting ED LOS for over 12 h were isolation (OR = 2.39, CI = 1.409-4.052), unaccompanied police officers (OR = 2.106, CI = 1.338-3.316), night-time visits (OR = 2.127, CI = 1.357-3.332), use of sedatives (OR = 1.671, CI = 1.030-2.713), and restraints (OR = 1.968, CI = 1.172-4.895). The ED LOS of psychiatric emergency patients is longer than that of general emergency patients, and a long ED LOS causes ED overcrowding. To reduce the ED LOS of psychiatric emergency patients, they must be accompanied by a police officer when visiting the ED, and the treatment process should be reorganized so that a psychiatrist can promptly intervene. Furthermore, it is necessary to reorganize the isolation guidelines and admission criteria for mental emergency patients.

Management of low back pain in Australian emergency departments for culturally and linguistically diverse populations from 2016 to 2021.

BACKGROUND: Disparate care in the ED for minority populations with low back pain is a long-standing issue reported in the USA. Our objective was to compare care delivery for low back pain in Australian EDs between culturally and linguistically diverse (CALD) and non-CALD patients. METHODS: This is a retrospective review of medical records of the ED of three public hospitals in Sydney, New South Wales, Australia from January 2016 to October 2021. We included adult patients diagnosed with non-serious low back pain at ED discharge. CALD status was defined by country of birth, preferred language and use of interpreter service. The main outcome measures were ambulance transport, lumbar imaging, opioid administration and hospital admission. RESULTS: Of the 14 642 included presentations, 7656 patients (52.7%) were born overseas, 3695 (25.2%) preferred communicating in a non-English language and 1224 (8.4%) required an interpreter. Patients born overseas were less likely to arrive by ambulance (adjusted OR (aOR) 0.68, 95% CI 0.63 to 0.73) than Australian-born patients. Patients who preferred a non-English language were also less likely to arrive by ambulance (aOR 0.82, 95% CI 0.75 to 0.90), yet more likely to be imaged (aOR 1.12, 95% CI 1.01 to 1.23) or be admitted to hospital (aOR 1.16, 95% CI 1.04 to 1.29) than Native-English-speaking patients. Patients who required an interpreter were more likely to receive imaging (aOR 1.43, 95% CI 1.25 to 1.64) or be admitted (aOR 1.49, 95% CI 1.29 to 1.73) compared with those who communicated independently. CALD patients were generally less likely to receive weak opioids than non-CALD patients (aOR range 0.76-0.87), yet no difference was found in the use of any opioid or strong opioids. CONCLUSION: Patients with low back pain from a CALD background, especially those lacking English proficiency, are significantly more likely to be imaged and admitted in Australian EDs. Future interventions improving the quality of ED care for low back pain should give special consideration to CALD patients.

Study of coronary artery bypass grafting admission in Covid-19 era: A bicentric study

The Covid-19 pandemic that began in December 2019 and is still underway in 2022 has changed many habits and protocols in different economic industries including healthcare. In the specific case, the change in protocols and management of work activities also affected the health sector. Among the sectors in which the pandemic has influenced the flow of events is the cardiology sector. In the specific case, the present work will present how coronary bypass interventions have been influenced in their different aspects by the Covid-19 pandemic. The work will be based on a comparison between the 2019 data in the period prior to the pandemic and in 2020 in the post-pandemic period for two major public hospitals in the Campania region: The university hospital of Salerno (Italy) "San Giovanni di Dio and Ruggi D'Aragona"and AORN "A. Cardarelli "of Naples (Italy). Both the structures considered have an Emergency Department and First Aid Acceptance for surgical pathologies. © 2022 ACM.

Implementation of DMAIC Cycle to Study the Impact of COVID-19 on Emergency Department-LOS

Lean Six Sigma (LSS) is a methodological approach that originated in industry and has, over time, become increasingly popular in healthcare. Its tool-to, the DMAIC cycle, consisting of 5 main steps, offers methodological rigor that helps improve processes by comparing results quantitatively. In this study, the LSS and in particular the DMAIC cycle was used to investigate the impact of COVID-19 on patients' length of stay in the Emergency Department (ED-LOS) of the Evangelical Hospital "Betania” of Naples (Italy). The study revealed a general increase in ED-LOS due mainly to the new steps that the hospital added to the standard flow, such as those for performing screening swabs, and the reduction of treatment stations, with the exception of patients discharged home for whom there was a statistically significant reduction. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Emergency Nurses' Compliance with Standard Precautions during the COVID-19 Pandemic at Governmental Hospitals in Hail City, Kingdom of Saudi Arabia.

Background: This study was conducted to assess nurses' compliance with standard precautions during COVID-19 pandemic at emergency departments, Hail city, Saudi Arabia. Methods: A cross-sectional study was conducted in the year 2021, at emergency departments of governmental hospitals in Hail city, Saudi Arabia. A total of 138 emergency nurses were selected using a census sampling method, and included in the current study. Of them, 56(40.6%) were from King Khalid Hospital, 35(25.4%) from King Salman Specialist Hospital, 28(20.3%) from Sharaf Urgent Care Hospital, and 19(13.8%) from Maternity and Child Hospital. The compliance with standard precautions scale was used, and socio-demographic characteristics were assessed using a structured questionnaire. Statistical analysis was performed using SPSS version 28. Results: A large percentage (71.0%) of the studied nurses were females, and (78.3%) were Saudi. The mean scores of compliances with standard precautions ranged from 3.1 to 3.9 out of 4. The overall compliance rate with all components of standards precautions was optimal (92.75%). Significant statistical differences were found in the mean scores of the "prevention of cross infection from person to person" with age; and between the mean scores of the "decontamination of spills and used article" with profession carrier P-values = 0.013, and 0.016, respectively. Conclusions: The compliance with standard precautions by emergency nurses was optimal (more than 90%). The mean compliance scores with the standard precautions could be associated with age and professional category. Continuous training program to enhance compliance with standard precautions among emergency nurses with continuous follow up and evaluation are recommended.

Otolaryngologic Presentations to Emergency Departments During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis.

OBJECTIVES: To perform a systematic review of otolaryngologic presentation rates to emergency department settings before and after lockdown due to the COVID-19 pandemic. SOURCES: PubMed, Scopus, and CINAHL. METHODS: A systematic search was conducted following PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses) for studies describing otolaryngologic presentations to emergency department and rapid access clinic settings both in the before-lockdown and after-lockdown periods. The start of after-lockdown period varied based on initiation of lockdown, ranging from March 1st to June 1st of 2020 across general emergency department studies. RESULTS: A total of 14 studies were included in this review. About 10 were general emergency departments, 3 were specifically pediatric emergency departments, and 1 study focused on the geriatric population (>65 years). A total of 13 790 patients were included, with 9446 in the before-lockdown period (68.5%) and 4344 in the after-lockdown period (31.5%). Meta-analysis of proportions for otolaryngologic presentations across general emergency departments was performed. Comparison of weighted proportions found significant differences between before-lockdown and after-lockdown presentation rates for infectious etiologies, tonsillitis specifically, foreign bodies, non-infectious airway issues, and epistaxis among these studies. CONCLUSIONS: The increased proportions of various non-infectious presentations (eg, epistaxis, foreign bodies, and airway issues) following lockdown might be associated with proportional decreases in infectious pathologies, given decreased social contact to prevent SARS-CoV-2 transmission. Overall, it is important for otolaryngologists to recognize what presentations might more commonly be seen and require evaluation and potential intervention in light of a global pandemic.

The lived experiences of health care professionals regarding visiting restrictions in the emergency department during the COVID-19 pandemic: A multi-perspective qualitative study.

AIMS: To explore the lived experiences of emergency department (ED) healthcare professionals regarding visiting restrictions during the COVID-19 pandemic. DESIGN: A qualitative phenomenology study. METHODS: Semi-structured interviews were undertaken. Participants consisted of 10 physicians, 20 clinical nurses, and three managers, who were purposefully selected from two EDs in China between April and July 2021. Colaizzi's approach guided data analysis. RESULTS: Four themes arose: (i) burden moral injury, (ii) higher workload to provide and support patient- and family-centered care, (iii) dissatisfied and unsafe healthcare service for patients and families, and (iv) tailoring strategies to provide family-centered care. PATIENT OR PUBLIC CONTRIBUTION: This study explored the lived experiences of ED health care professionals regarding visiting restrictions during the COVID-19 pandemic. Noted challenges included communicating with families and ethical decision making. Strategies that support ED clinician welfare, and communication with families are warranted if visiting policy restrictions are continued or re-introduced.

A Fuzzy Hybrid MCDM Approach for Assessing the Emergency Department Performance during the COVID-19 Outbreak.

The use of emergency departments (EDs) has increased during the COVID-19 outbreak, thereby evidencing the key role of these units in the overall response of healthcare systems to the current pandemic scenario. Nevertheless, several disruptions have emerged in the practical scenario including low throughput, overcrowding, and extended waiting times. Therefore, there is a need to develop strategies for upgrading the response of these units against the current pandemic. Given the above, this paper presents a hybrid fuzzy multicriteria decision-making model (MCDM) to evaluate the performance of EDs and create focused improvement interventions. First, the intuitionistic fuzzy analytic hierarchy process (IF-AHP) technique is used to estimate the relative priorities of criteria and sub-criteria considering uncertainty. Then, the intuitionistic fuzzy decision making trial and evaluation laboratory (IF-DEMATEL) is employed to calculate the interdependence and feedback between criteria and sub-criteria under uncertainty, Finally, the combined compromise solution (CoCoSo) is implemented to rank the EDs and detect their weaknesses to device suitable improvement plans. The aforementioned methodology was validated in three emergency centers in Turkey. The results revealed that the most important criterion in ED performance was ER facilities (14.4%), while Procedures and protocols evidenced the highest positive D + R value (18.239) among the dispatchers and is therefore deemed as the main generator within the performance network.

Identifying a more severe emergent COVID-19 variant using Emergency Departments' routinely collected clinical measures.

Objective: To determine whether a clinical scoring system (the mPRIEST score) could be used to identify an emerging coronavirus disease 2019 (COVID-19) variant with increased clinical severity. Design: Cross sectional study comparing two time periods (Delta and Omicron waves). Setting: Public Emergency Departments in Northern Sydney Local Health District. Participants: Patients presenting during August 2021 (Delta wave) and January 2022 (Omicron wave) with confirmed COVID-19. Data on age, gender, temperature, heart rate, systolic blood pressure, respiratory rate, oxygen saturation and mental status were extracted from patients' electronic medical records to assess clinical disease severity at presentation. Main outcome measures: Modified Pandemic Respiratory Infection Emergency System Triage (mPRIEST) score calculated using routinely collected data. Results: A sample of 262 records of COVID-19 positive patients presenting during the Delta and initial Omicron waves were reviewed with 205 having COVID-19 as their primary diagnosis. During the Delta wave 48.1% had scores above 4 compared to 35.1% for the Omicron wave (p = 0.03). The median score was also significantly higher for the Delta group (4 vs 3; p = 0.01). Hospitalisations, admissions to ICU and deaths during admission were higher among patients presenting during the Delta wave than among those presenting during the Omicron wave. Conclusion: The mPRIEST score was significantly higher for patients for whom the predominant circulating variant was Delta than those for whom the predominant circulating variant was Omicron. This finding is consistent with international reporting of severity measured by hospital admission data and demonstrates the score's possible ability to identify an emergent strain with higher morbidity and mortality.

Perspectives of Frequent Users of Emergency Departments on a Case Management Intervention: A Qualitative Study.

BACKGROUND: Effective management of frequent users of emergency departments (FUED) remains challenging. Case management (CM) has shown to improve patient quality of life while reducing ED visits and associated costs. However, little data is available on FUED's perception of CM outside of North America to further improve CM implementation. OBJECTIVES: Explore the FUED's perspectives about CM in Switzerland. DESIGN, SETTING & PARTICIPANTS: Semi-structured qualitative interviews eliciting FUED's experiences of CM were conducted among 20 participants (75% female; mean age = 40.6, SD = 12.8) across 6 hospital ED. OUTCOMES MEASURES & ANALYSIS: Inductive content analysis. MAIN RESULTS: Most participants were satisfied with the CM program. In particular, FUEDs identified the working relationship with the case manager (cm) as key for positive outcomes, and also valued the holistic evaluation of their needs and resources. Overall, patients reported increased motivation and health literacy, as well as facilitated interactions within the healthcare system. Conversely, a small number of participants reported negative views on CM (ie, stigmatization, lack of concrete outcomes). Barriers identified were cm's lack of time, COVID-19's negative impact on CM organization, as well as lack of clarity on the objectives of CM. FUED perceived CM as useful, in particular establishing a working relationship with the cm. Our results suggest that CM can be further improved by (1) professionals remaining non-judgmental toward FUED, (2) making sure the aims and objectives of the CM are understood by the participants, and (3) allowing more time for the cm to carry out their work.

Humans not heroes: Canadian emergency physician experiences during the early COVID-19 pandemic.

BACKGROUND: The pandemic has upended much clinical care, irrevocably changing our health systems and thrusting emergency physicians into a time of great uncertainty and change. This study is a follow-up to a survey that examined the early pandemic experience among Canadian emergency physicians and aimed to qualitatively describe the experiences of these physicians during the global pandemic. The study was conducted at a time when Canadian COVID-19 case numbers were low. METHODS: The investigators engaged in an interview-based study that used an interpretive description analytic technique, sensitised by the principles of phenomenology. One-to-one interviews were conducted, transcribed and then analysed to establish a codebook, which was subsequently grouped into key themes. Results underwent source triangulation (with survey data from a similar period) and investigator-driven audit trail analysis. RESULTS: A total of 16 interviews (11 female, 5 male) were conducted between May and September 2020. The isolated themes on emergency physicians' experiences during the early pandemic included: (1) disruption and loss of emergency department shift work; (2) stress of COVID-19 uncertainty and information bombardment; (3) increased team bonding; (4) greater personal life stress; (5) concern for patients' isolation, miscommunication and disconnection from care; (6) emotional distress. CONCLUSIONS: Canadian emergency physicians experienced emotional and psychological distress during the early COVID-19 pandemic, at a time when COVID-19 prevalence was low. This study's findings could guide future interventions to protect emergency physicians against pandemic-related distress.

Measuring occupational stress in emergency departments.

OBJECTIVE: EDs are highly demanding workplaces generating considerable potential for occupational stress experiences. Previous research has been limited by a focus on specific aspects of the working environment and studies focussing on a range of variables are needed. The aim of the present study was to describe the perceptions of occupational stress and coping strategies of ED nurses and doctors and the differences between these two groups. METHODS: This cross-sectional study was conducted at a public metropolitan hospital ED in Queensland, Australia. All ED nurses and doctors were invited to participate in an electronic survey containing 13 survey measures and one qualitative question assessing occupational stress and coping experiences. Descriptive statistics were employed to report stressors. Responses to open-ended questions were thematically analysed. RESULTS: Overall, 104 nurses and 35 doctors responded (55.6% response rate). Nurses reported higher levels of both stress and burnout than doctors. They also reported lower work satisfaction, work engagement, and leadership support than doctors. Compared with doctors, nurses reported significantly higher stress from heavy workload/poor skill mix, high acuity patients, environmental concerns, and inability to provide optimal care. Thematic analysis identified high workload and limited leadership and management support as factors contributing to stress. Coping mechanisms, such as building personal resilience, were most frequently reported. CONCLUSIONS: The present study found organisational stressors adversely impact the well-being of ED nurses and doctors. Organisational-focused interventions including leadership development, strategic recruitment, adequate staffing and resources may mitigate occupational stress and complement individual coping strategies. Expanding this research to understand broader perspectives and especially the impact of COVID-19 upon ED workers is recommended.

Simulation-based optimisation: analysis of the emergency department resources under COVID-19 conditions

The emergency department (ED) is the most important section in every hospital. The ED behaviour is adequately complex, because the ED has several uncertain parameters such as the waiting time of patients or arrival time of patients. To deal with ED complexities, this paper presents a simulation-based optimisation-based meta-model (S-BO-BM-M) to minimise total waiting time of the arriving patients in an emergency department under COVID-19 conditions. A full-factorial design used meta-modelling approach to identify scenarios of systems to estimate an integer nonlinear programming model for the patient waiting time minimisation under COVID-19 conditions. Findings showed that the S-BO-BM-M obtains the new key resources configuration. Simulation-based optimisation meta-modelling approach in this paper is an invaluable contribution to the ED and medical managers for the redesign and evaluates of current situation ED system to reduce waiting time of patients and improve resource distribution in the ED under COVID-19 conditions to improve efficiency. Copyright © 2023 Inderscience Enterprises Ltd.

Violence Against Physicians in the Workplace: Trends, Causes, Consequences, and Strategies for Intervention.

PURPOSE: Violence against healthcare professionals has become an emergency in many countries. Literature in this area has mainly focused on nurses while there are less studies on physicians, whose alterations in mental health and burnout have been linked to higher rates of medical errors and poorer quality of care. We summarized peer-reviewed literature and examined the epidemiology, main causes, consequences, and areas of intervention associated with workplace violence perpetrated against physicians. RECENT FINDINGS: We performed a review utilizing several databases, by including the most relevant studies in full journal articles investigating the problem. Workplace violence against doctors is a widespread phenomenon, present all over the world and related to a number of variables, including individual, socio-cultural, and contextual variables. During the COVID-19 pandemic, incidence of violence has increased. Data also show the possible consequences in physicians' deterioration of quality of life, burnout, and traumatic stress which are linked to physical and mental health problems, which, in a domino effect, fall on patients' quality of care. Violence against doctors is an urgent global problem with consequences on an individual and societal level. This review highlights the need to undertake initiatives aimed at enhancing understanding, prevention, and management of workplace violence in healthcare settings.

The lung ultrasound "Rule of 7" in the prognosis of COVID-19 patients: Results from a prospective multicentric study.

Purpose: There is growing evidence regarding the imaging findings of coronavirus disease 2019 (COVID-19) in lung ultrasound (LUS), however the use of a combined prognostic and triage tool has yet to be explored.To determine the impact of the LUS in the prediction of the mortality of patients with highly suspected or confirmed COVID-19.The secondary outcome was to calculate a score with LUS findings with other variables to predict hospital admission and emergency department (ED) discharge. Material and methods: Prospective study performed in the ED of three academic hospitals. Patients with highly suspected or confirmed COVID-19 underwent a LUS examination and laboratory tests. Results: A total of 228 patients were enrolled between March and September 2020. The mean age was 61.9 years (Standard Deviation - SD 21.1). The most common findings in LUS was a right posteroinferior isolated irregular pleural line (53.9%, 123 patients). A logistic regression model was calculated, including age over 70 years, C-reactive protein (CRP) over 70 mg/L and a lung score over 7 to predict mortality, hospital admission and discharge from the ED. We obtained a predictive model with a sensitivity of 56.8% and a specificity of 87.6%, with an AUC of 0.813 [p < 0.001]. Conclusions: The combination of LUS, clinical and laboratory findings in this easy to apply "rule of 7" showed excellent performance to predict hospital admission and mortality.

Objetivo: Existe una evidencia creciente con respecto a los hallazgos de imagen de la enfermedad por coronavirus 2019 (COVID-19) en la ecografía pulmonar (LUS), sin embargo, aún no se ha explorado el uso de una herramienta combinada de pronóstico y triaje.El objetivo principal de este estudio fue determinar el impacto de la LUS en la predicción de la mortalidad de los pacientes con sospecha de afectación pulmonar por COVID-19. El objetivo secundario fue calcular una puntuación con los hallazgos del LUS con otras variables para predecir el ingreso hospitalario y el alta del servicio de urgencias (SU). Material y métodos: Estudio prospectivo realizado en urgencias de tres hospitales académicos, en pacientes con sospecha de COVID-19 o confirmación de esta, a los que se sometió a un examen de LUS y pruebas de laboratorio. Resultados: Se inscribieron un total de 228 pacientes entre marzo y septiembre de 2020. La edad media fue de 61,9 años (DE 21,1). El hallazgo más común en la LUS fue la irregularidad pleural posteroinferior derecha (53,9%, 123 pacientes). Se calculó un modelo de regresión logística, que incluyó la edad mayor de 70 años, proteína C reactiva (PCR) mayor de 70 mg/L y puntuación de afectación pulmonar mediante LUS score superior a 7 para predecir la mortalidad, el ingreso hospitalario y el alta del SU. Se obtuvo una sensibilidad del 56,8% y una especificidad del 87,6%, con un AUC de 0,813 [p < 0,001] para dicho modelo predictivo, en materia de mortalidad. Conclusiones: La combinación de LUS, hallazgos clínicos y de laboratorio en esta «regla de 7¼ de fácil aplicación se mostró de utilidad para predecir el ingreso hospitalario y la mortalidad.