Evaluation of CLINITEST® Rapid Covid-19 + Influenza antigen test in a cohort of symptomatic patients in an emergency department.

OBJECTIVES: Rapid management of patients with respiratory tract infections in hospital emergency departments is one of the main objectives since the concurrent circulation of respiratory viruses following the SARS-CoV-2 pandemic. The use of new combined point-of-care antigen tests for detecting influenza A/B and SARS-CoV-2 represents an advantage in response time over the molecular tests. The objective was to evaluate the suitability of the CLINITEST® Rapid Covid-19 + Influenza Antigen test (Siemens Healthineers, Germany) (RCIA test) by measuring the sensitivity, specificity, Cohen's kappa, and cut-off values. METHODS: Nasopharyngeal samples were collected from a randomised group of symptomatic patients of all ages at emergency department during January-February 2023. In parallel, these patients were screened for influenza A/B, and SARS-CoV-2 using RT-PCR. The Ct (cycle threshold) values were collected for positive [RT-PCR (+) /RCIA test (+)] and false negative [(RT-PCR (+) /RCIA test (-)] samples. A subanalysis was performed in the paediatric population (< 16 years-old). RESULTS: We included 545 patients (55.8% females) with a median age of 7 years-old (IQR: 1-66.5). The RCIA test showed a sensitivity of 59.7% [95%CI: 46.9-67.33] for influenza A, 65.6% [95%CI: 49.5-80.3] for influenza B, and 76.9% [95%CI: 45.8-84.8] for SARS-CoV-2. The specificity was between 90.7%-99.7% with a moderate/high level of agreement with RT-PCR (kappa score: 0.6-0.8) for the three respiratory viruses included in the RCIA test. CONCLUSIONS: The sensitivity of the RCIA test is insufficient for screening of patients, including patients with low Ct values (Ct > 20). Despite its good specificity and Cohen's kappa value, its use as a screening test is not comparable to RT-PCR systems in the ED environment with a high number of false negative results.

A Cohort of Patients with COVID-19 in a Major Teaching Hospital in Europe.

BACKGROUND: Since the confirmation of the first patient infected with SARS-CoV-2 in Spain in January 2020, the epidemic has grown rapidly, with the greatest impact on the region of Madrid. This article describes the first 2226 adult patients with COVID-19, consecutively admitted to La Paz University Hospital in Madrid. METHODS: Our cohort included all patients consecutively hospitalized who had a final outcome (death or discharge) in a 1286-bed hospital of Madrid (Spain) from 25 February (first case admitted) to 19 April 2020. The data were manually entered into an electronic case report form, which was monitored prior to the analysis. RESULTS: We consecutively included 2226 adult patients admitted to the hospital who either died (460) or were discharged (1766). The patients' median age was 61 years, and 51.8% were women. The most common comorbidity was arterial hypertension (41.3%), and the most common symptom on admission was fever (71.2%). The median time from disease onset to hospital admission was 6 days. The overall mortality was 20.7% and was higher in men (26.6% vs. 15.1%). Seventy-five patients with a final outcome were transferred to the intensive care unit (ICU) (3.4%). Most patients admitted to the ICU were men, and the median age was 64 years. Baseline laboratory values on admission were consistent with an impaired immune-inflammatory profile. CONCLUSIONS: We provide a description of the first large cohort of hospitalized patients with COVID-19 in Europe. Advanced age, male sex, the presence of comorbidities and abnormal laboratory values were more common among the patients with fatal outcomes.

Mortalidad en el traumatismo potencialmente grave atendido en un servicio de urgencias de tercer nivel. Evaluación de la escala pronóstico de mortalidad GAP / Mortality in patients with potentially severe trauma in a tertiary care hospital emergency department and evaluation of risk prediction with the GAP prognostic scale

Objetivo: Describir la mortalidad de los pacientes atendidos con traumatismos potencialmente graves (TPG) y la correlación de dicha mortalidad con la escala GAP (Glasgow coma scale, Age, and systolic bloob Pressure). Métodos: Estudio observacional retrospectivo con inclusión de todos los pacientes atendidos en urgencias durante 15 meses con TPG. Se registraron variables epidemiológicas, mecanismo lesional, tipo de traslado, necesidad de intubación orotraqueal extrahospitalaria, consumo de tóxicos, índice de comorbilidad de Charlson (ICC), variables incluidas en la escala de GAP, el destino tras la asistencia en urgencias y al final del episodio y la mortalidad. Resultados: Se incluyeron 864 pacientes. La mortalidad fue mayor en pacientes mayores [57,9 (26,6) vs 41,1 (17,4), p < 0,05] y con mayor puntuación en el ICC [3,3 (2,9) vs 0,9 (1,7)]. La precipitación fue el tipo de accidente con mayor mortalidad (p < 0,001). No hubo asociación entre tóxicos y mortalidad. En los fallecidos tuvieron menor puntuación enla escala del coma de Glasgow [9,1 (5,3) vs 14,8 (1,2), p < 0,001], como la presión arterial sistólica [113,8 (19,8) vs 131,3 (20,7) mmHg, p = 0,012] y la diastólica [60,1 (16,8) vs 77,7 (11,7) mmHg, p = 0,002]. La puntuación en la escala GAP fue menor en los fallecidos frente a los supervivientes [5,1 (4,8) vs 22,6 (1,7), p < 0,001]. En el análisis multivariantese mantuvieron significativos el ICC (OR: 0,704; IC 95%: 0,52-0,96) y la escala GAP (OR: 1,8; IC 95%: 1,45-2,20). Conclusiones: La mortalidad de nuestra serie de pacientes es baja en relación a lo publicado con anterioridad. El GAP es útil como escala pronóstica de mortalidad en nuestra cohorte de pacientes (AU)

Objective: To assess mortality in patients with potentially severe injuries and explore the correlation between mortality and the score on the GAP scale (Glasgow Coma Scale, age, and systolic blood pressure). Methods: Retrospective observational study of all patients with potentially severe injuries treated in an emergency department (ED) over a period of 15 months. We recorded epidemiologic variables, cause of injury, type of transport, need for prehospital orotracheal intubation, substance abuse, Charlson Comorbidity Index (CCI), variables for the GAP prognostic score, destination on discharge from the ED and at the end of the episode, and mortality. Results: Data for 864 patients entered the final analysis. Mortality was higher in older patients (mean [SD] age, 57.9 [26.6] vs 41.1 [17.4], P< 05) and those with a higher mean CCI (3.3 [2.9] vs 0.9 [1.7]). Accident type was a precipitating factor associated with mortality (P< 001), but substance abuse was unrelated. Patients who died had lower mean Glasgow scores (9.1 [5.3] vs 14.8 [1.2], P< 001) and lower mean systolic and diastolic pressures (respectively, 113.8 [19.8] vs 131.3 [20.7] mm Hg, P=.012, and 60.1 [16.8] vs 77.7 [11.7] mm Hg, P=.002). Patients who died also had lower mean GAP scores than survivors (15.1 [4.8] vs 22.6 [1.7], P< 001). Risk factors that remained significant in the multivariate analysis were CCI (odds ratio [OR], 0.704; 95% CI, 0.52-0.96) and GAP score (OR, 1.8; 95% CI, 1.45-2.20). Conclusions: Mortality in our patient series was lower than rates in previously published reports. The GAP score was a useful tool for predicting mortality in the series we studied (AU)

[Mortality in patients with potentially severe trauma in a tertiary care hospital emergency department and evaluation of risk prediction with the GAP prognostic scale]. / Mortalidad en el traumatismo potencialmente grave atendido en un servicio de urgencias de tercer nivel. Evaluación de la escala pronóstico de mortalidad GAP.

OBJECTIVES: To assess mortality in patients with potentially severe injuries and explore the correlation between mortality and the score on the GAP scale (Glasgow Coma Scale, age, and systolic blood pressure). MATERIAL AND METHODS: Retrospective observational study of all patients with potentially severe injuries treated in an emergency department (ED) over a period of 15 months. We recorded epidemiologic variables, cause of injury, type of transport, need for prehospital orotracheal intubation, substance abuse, Charlson Comorbidity Index (CCI), variables for the GAP prognostic score, destination on discharge from the ED and at the end of the episode, and mortality. RESULTS: Data for 864 patients entered the final analysis. Mortality was higher in older patients (mean [SD] age, 57.9 [26.6] vs 41.1 [17.4], P<.05) and those with a higher mean CCI (3.3 [2.9] vs 0.9 [1.7]). Accident type was a precipitating factor associated with mortality (P<.001), but substance abuse was unrelated. Patients who died had lower mean Glasgow scores (9.1 [5.3] vs 14.8 [1.2], P<.001) and lower mean systolic and diastolic pressures (respectively, 113.8 [19.8] vs 131.3 [20.7] mm Hg, P=.012, and 60.1 [16.8] vs 77.7 [11.7] mm Hg, P=.002). Patients who died also had lower mean GAP scores than survivors (15.1 [4.8] vs 22.6 [1.7], P<.001). Risk factors that remained significant in the multivariate analysis were CCI (odds ratio [OR], 0.704; 95% CI, 0.52-0.96) and GAP score (OR, 1.8; 95% CI, 1.45-2.20). CONCLUSION: Mortality in our patient series was lower than rates in previously published reports. The GAP score was a useful tool for predicting mortality in the series we studied.

OBJETIVO: Describir la mortalidad de los pacientes atendidos con traumatismos potencialmente graves (TPG) y la correlación de dicha mortalidad con la escala GAP (Glasgow coma scale, Age, and systolic bloob Pressure). METODO: Estudio observacional retrospectivo con inclusión de todos los pacientes atendidos en urgencias durante 15 meses con TPG. Se registraron variables epidemiológicas, mecanismo lesional, tipo de traslado, necesidad de intubación orotraqueal extrahospitalaria, consumo de tóxicos, índice de comorbilidad de Charlson (ICC), variables incluidas en la escala de GAP, el destino tras la asistencia en urgencias y al final del episodio y la mortalidad. RESULTADOS: Se incluyeron 864 pacientes. La mortalidad fue mayor en pacientes mayores [57,9 (26,6) vs 41,1 (17,4), p < 0,05] y con mayor puntuación en el ICC [3,3 (2,9) vs 0,9 (1,7)]. La precipitación fue el tipo de accidente con mayor mortalidad (p < 0,001). No hubo asociación entre tóxicos y mortalidad. En los fallecidos tuvieron menor puntuación en la escala del coma de Glasgow [9,1 (5,3) vs 14,8 (1,2), p < 0,001], como la presión arterial sistólica [113,8 (19,8) vs 131,3 (20,7) mmHg, p = 0,012] y la diastólica [60,1 (16,8) vs 77,7 (11,7) mmHg, p = 0,002]. La puntuación en la escala GAP fue menor en los fallecidos frente a los supervivientes [5,1 (4,8) vs 22,6 (1,7), p < 0,001]. En el análisis multivariable se mantuvieron significativos el ICC (OR: 0,704; IC 95%: 0,52-0,96) y la escala GAP (OR: 1,8; IC 95%: 1,45-2,20). CONCLUSIONES: La mortalidad de nuestra serie de pacientes es baja en relación a lo publicado con anterioridad. El GAP es útil como escala pronóstica de mortalidad en nuestra cohorte de pacientes.