Does a Low Score in the Respiratory Visual Triage Tool Predict a Negative COVID-19 Test in an Admitted Patient?

Background: Fast and accurate COVID-19 identification is important to population and epidemic monitoring in hospitals. Visual triage or respiratory triage should be efficient and utilized as visual clues to alert HCWs on the case definitions. Objective: This study aims to evaluate the diagnostic value of the respiratory triage for COVID-19 infections and to evaluate the efficacy of the MOH triage tool in identifying low risk patients. Methods: A single-center retrospective chart review that was conducted at King Fahd Hospital of the University (KFHU), Khober, KSA on all adult patients admitted to the hospital through the ED. The visual triage checklist comprises two main sections, with one focused on the risk of exposure and the other related to patient clinical signs and symptoms, each with a defined score where any score ≥ 4 will need to isolate and assessed by the physician while a score of less than 4 means that the patient can be admitted with other patients. The hospital swabbed all admitted patients regardless of their score. We compared their PCR result with their case definition score. The collected data was entered and analyzed using the Statistical Package for the Social Science (SPSS Inc. Chicago, IL, USA) version 23. Results: The study included 7258 participants. 20% of participants aged between 21 to 30 years old, 52.2% of sample were females, and 78% were Saudi nationality. Visual triage score was less than 4 in n= 4745 participants (65.4%) and 4 or more in n= 2513 (34.6%). The test had sensitivity of 75% and specificity 21%. Conclusion: Most studies shows that COVID 19 has an infectivity rate of 18 to 30%. Based on this low sensitivity result, using the screening tool alone puts patients and HCWs at risk of getting infected with COVID 19.

Incidental finding of asymptomatic non-traumatic pericardial effusion in a trauma patient: a case report.

Pericardial effusion can either be an incidental finding or a manifestation of systemic or cardiac disease. It has a wide range of presentations, from asymptomatic small effusion to rapidly progressive fatal tamponade. In a trauma setting, pericardial effusion is usually attributed to hematoma collection, with the concern of clinical evidence of tamponade that can lead to cardiopulmonary collapse. The Focused Assessment with Sonography for Trauma (FAST) is a widely used tool to diagnose pericardial effusion in trauma patients. We published this case report to emphasize that the presence of pericardial effusion alone in a trauma patient does not indicate the presence of tamponade. This case concerns a 39 years old male patient who presented to ER as a trauma case after a fall from two meters height and landing on his feet. ATLS protocol was followed, and FAST showed an incidental finding of massive pericardial fluid. The trauma team was consulted, and the patient was hemodynamically stable without clinical evidence of tamponade. Echocardiography showed mitral valve stenosis and large pericardial effusion. The close observation did not suggest the presence of cardiac tamponade. The pericardial catheter was inserted during admission with drainage of 900cc of serous fluid. The presence of pericardial fluid in a trauma setting does not confirm the diagnosis of tamponade. The mechanism of injury, clinical presentation, and the patient's stability are essential factors in determining further management of such patients.