The Role of the Quick Sequential Organ Failure Assessment Score (qSOFA) in the Pre-Hospitalization Prediction of Coronavirus Disease 2019 (COVID-19) Prognosis

Objective: Researchers have been investigating numerous biomarkers and scoring systems to predict the prognosis of coronavirus disease 2019 (COVID-19). We aimed to determine the effectiveness of the quick sequential organ failure assessment (qSOFA) scoring system in pre-hospital emergency health care for predicting COVID-19 prognosis in terms of the intensive care unit (ICU) admission and mortality. Materials and Methods: We enrolled 9850 patients suspected to have COVID-19 who were transferred by 112 emergency medical services (EMS) between April 1, 2020 and July 1, 2020. Demographic and clinical data of the patients were obtained from the Ankara Emergency Health Services Automation System. The qSOFA score was calculated based on the data obtained from the ambulance medical records. Results: The 28-day mortality rate was 6.2% (n=13) and the cut-off for the qSOFA score was >1 [area under the curve (AUC)=0.955, sensitivity 84.62%, specificity 90.4%, p<0.001, 95% confidence interval (CI): 0.918-0.979)]. The cut-off for ICU admission was a qSOFA score >1 (AUC=0.942;sensitivity 97.37%;specificity 84.97%;p<0.001;95% CI, 0.901-0.969). The mortality risk was 51.8 times more in patients with a high qSOFA score (p<0.001;95% CI, 10.682-251.340). Moreover, patients with a high qSOFA score were 47.7 times more likely to require ICU admission (p<0.001;95% CI, 16.735-136.039). Conclusion: Thus, the pre-hospital qSOFA score that comprises the ambulance vital signs of the patients can be used to predict ICU admissions and mortality in patients with COVID-19. [ABSTRACT FROM AUTHOR] Copyright of Erciyes Medical Journal / Erciyes Tip Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Accuracy of Bedside Lung Ultrasound as a Rapid Triage Tool for Suspected Covid-19 Cases.

OBJECTIVES: The novel coronavirus disease 2019 (Covid-19) outbreak began in China. The characteristic of the disease is development of pneumonia. We aimed to investigate the accuracy of bedside lung ultrasound (BLUS) for diagnosing Covid-19 pneumonia, and its effectiveness for the correct triage of patients with suspected Covid-19 in the emergency department (ED). METHODS: This study was a prospective, cross-sectional cohort study. During their shifts, 3 accredited and certificated emergency physicians performed BLUS using BLUE protocol at the triage area of the ED on patients with suspected Covid-19. All of the patients underwent chest computed tomography. The BLUS findings were statistically compared with formal radiology reports of computed tomographies as the criterion standard for the diagnosis of Covid-19 pneumonia. Kolmogorov-Smirnov analysis, Shapiro-Wilk test, and Q-Q plots were performed with 95% confidence intervals (CIs) for statistical analysis. RESULTS: A total of 72 patients were included in the study. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of BLUS were 96.9% (95% CI, 84.2%-99.9%), 92.3% (95% CI, 79.1%-98.3%), 84.3% (95% CI, 64.5%-94.1%), 98.6% (95% CI, 91.1%-99.8%), and 93.7% (95% CI, 85.3%-98.0%), respectively. The positive and negative predictive values were 84.3% (95% CI, 64.5%-94.1%) and 98.6% (95% CI, 91.1%-99.8%), respectively. The area under curve was found to be 0.946 (95% CI, 0.866-0.986; P < 0.0001). CONCLUSIONS: Bedside lung ultrasound can be used to detect the presence of pulmonary involvement in suspected cases of Covid-19 for the effective triage of patients in the ED.

Effects of COVID-19 Pandemic on Emergency Medical Services.

INTRODUCTION: In this study, we aimed to analyse the changes that occurred after the COVID-19 pandemic using the data of EMS of Ankara province. MATERIALS AND METHODS: EMS data for the same time interval (March 11-April 24) in the last 3 years (2018, 2019 and 2020) were compared. RESULTS: While the number of calls increased by 90.9% during the pandemic period (from 2019 to 2020), the number of cases increased by 9.8%. Of all cases transported to hospital, 15.2% were suspected of and 2.9% were diagnosed with COVID-19. In the pandemic period, case frequency decreased in the 0-6 age group (-4.1%) and 7-18 age group (-39.9%) while the number of patients in the 19-65 age group (12.9%) and 65+ age group (21.5%) increased. There was a statistically significant difference between pre-pandemic and pandemic period in terms of rural area case frequency. During the pandemic period, case frequency of angina pectoris (-35.2%), myocardial infarction (-45%), acute abdomen (-23.8%) and cerebrovascular diseases (-2.9%) decreased contrary to pre-pandemic period (2019). During the same period, symptoms of fever (+14.1%) and cough (+956.3%) increased. There was a statistically significant difference between pre-pandemic and pandemic period in terms of forensic case frequency (P < .05). In addition, there was a statistically significant difference between these periods in terms of the frequency of patients who died at the scene. CONCLUSION: Although the use of ambulances has increased in the pandemic process, the use of EMS for time-sensitive diseases has decreased.

Resuscitation of Patient with Suspected/Confirmed COVID-19: How to Increase Medical Staff Safety

Medical personnel, including physicians, nurses, and paramedics, as provided by the Center for Disease Control and Prevention, should be in full personal protective equipment (PPE) during aerosol-generating procedures (2,3). During CPR, however, performing chest compression may cause the rescuer’s face protection devices to adhere to exposing the rescuer to viral infection (5) poorly. Authorship Contributions Concept: T.E., L.S., Design: T.E., B.K., A.D., Data Collection or Processing: S.K., T.E., L.S., Analysis or Interpretation: T.E., A.D., LS., Literature Search: S.K., B.K., J.S., Writing: S.K., T.E., B.K., J.S., A.D., L.S. Conflict of Interest: No conflict of interest was declared by the authors.