Assessment of dental emergency management at the Rothschild hospital during the first lockdown due to COVID-19 pandemic

ABSTRACT

Background and Aim: Many obstacles have risen during the lockdown period due to the COVID-19 pandemic, including the provision of urgent dental care. The Rothschild hospital had to establish a balance between providing a core service and limiting patient admission through a fair sorting system. This study aims to assess the efficacy of the dental emergency protocol implemented during the first lockdown. Methods: The protocol was applied for patients who arrived at the hospital between March 18 and May 11, 2020. First, they underwent a sorting diagnosis (A) based on self-reported symptoms. If deemed as urgent, they were oriented towards dental professionals, who performed an intraoral examination leading to a clinical diagnosis (B). Diagnoses (A and B) were categorized into four groups infectious, prosthetic, traumatic, and other emergencies. The agreement between diagnoses A and B was tested (Cohen's Kappa score). Positive predictive value, negative predictive value, sensitivity and specificity among diagnostic categories were assessed to evaluate the performance and efficacy of the sorting diagnosis. Results: Out of 1651 dental visits, 1064 were included for this analysis. The most frequent reported symptom at the sorting diagnosis was pain (40%), whereas the most frequent clinical diagnosis was endodontic emergency (30%). Periodontal emergency concerned 6% of patients. Tooth extraction was required in 32% of cases;systemic antibiotics were prescribed for 49.2% of patients. Infectious emergency diagnosis had the higher sensitivity (94.2%), whereas prosthetic emergency diagnosis had the higher specificity (99.1%). The level of agreement was substantial (kappa > 0.6) for the majority of diagnoses. No Covid-19 contamination occurred. Conclusions: This study demonstrates that the implemented protocol during the first COVID-19 lockdown to manage dental emergencies was effective, establishing an appropriate patient orientation prior to clinical examination to minimize the risk of COVID-19 exposure whilst safeguarding professionals and patients.