The Challenge of Using an Antigen Test as a Screening Tool for SARS-CoV-2 Infection in an Emergency Department: Experience of a Tertiary Care Hospital in Southern Italy

Background. In emergency hospital settings, rapid diagnosis and isolation of SARS-CoV-2 patients are required. The aim of the study was to evaluate the performance of an antigen chemiluminescence enzymatic immunoassay (CLEIA) and compare it with that of Real-time Reverse transcription-Polymerase Chain Reaction (RT-qPCR), the gold standard assay, to assess its suitability as a rapid diagnostic method for managing patients in the emergency department (ED). Methods. Consecutive patients with no previous history of SARS-CoV-2 infection attending the ED of the Policlinico Hospital of Bari between 23rd October and 4th November 2020 were enrolled. Clinical and demographic data were collected for all patients. Nasopharyngeal swabs collected on admission were subjected both to molecular (RT-qPCR) and antigen (CLEIA) tests for SARS-CoV-2. The performance of the CLEIA antigen test was analyzed using R Studio software and Microsoft Excel. Receiver operating characteristics were also performed. Results. A total of 911 patients were enrolled, of whom 469 (51.5%) were male. Of the whole cohort, 23.7% tested positive for SARS-CoV-2 by RT-qPCR and 24.5% by CLEIA. The overall concordance rate was 96.8%. The sensitivity, specificity, positive predictive value, and negative predictive value of the antigen test were 94.9% (95% CI, 91.9–97.0), 97.4% (95% CI, 96.5–98.1), 91.9% (95% CI, 89.0–94.0), and 98.4% (95% CI, 97.4–99.1), respectively. The area under the curve (AUC) was 0.99. The kappa coefficient was 0.91. The overall positive and negative likelihood ratios were 37 (95% CI 23-58) and 0.05 (95% CI, 0.03–0.09), respectively. Conclusions. Data analysis demonstrated that the antigen test showed very good accuracy for discriminating SARS-CoV-2-infected patients from negative participants. The CLEIA is suitable for rapid clinical diagnosis of patients in hospital settings, particularly in EDs with a high prevalence of symptomatic patients and where a rapid turnaround time is critical. Timely and accurate testing for SARS-CoV-2 plays a crucial role in limiting the spread of the virus.

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Can troponin I measurement predict short-term serious cardiac outcomes in patients presenting to the emergency department with possible acute coronary syndrome?

CJEM ◽

10.1017/s1481803500008861 ◽

2004 ◽

Vol 6 (01) ◽

pp. 22-30 ◽

Cited By ~ 6

Author(s):

Stephen A. Hill ◽

P.J. Devereaux ◽

Lauren Griffith ◽

John Opie ◽

Matthew J. McQueen ◽

...

Keyword(s):

Emergency Department ◽

Acute Coronary Syndrome ◽

Troponin I ◽

Tertiary Care ◽

Cardiovascular Death ◽

Care Hospital ◽

Likelihood Ratios ◽

Coronary Syndrome ◽

Cardiac Outcomes ◽

Cardiac Outcome

ABSTRACT Objective: To determine the ability of troponin I (TnI) measurement to predict the likelihood of a serious cardiac outcome over the subsequent 72 hours in patients presenting to the emergency department (ED) with symptoms suggestive of an acute coronary syndrome. Methods: This prospective observational study enrolled consecutive patients presenting to 2 urban tertiary care hospital EDs over a 5-week period. Eligible patients included those for whom a TnI test was ordered within 24 hours of arrival and in whom no serious cardiac outcome occurred before the test result was available. Patients were followed for 72 hours and serious cardiac outcomes documented; these included cardiovascular death, myocardial infarction, congestive heart failure, serious arrhythmia and refractory pain. We calculated likelihood ratios (LRs) to describe the association of the TnI result with serious cardiac outcomes. Results: Of the 352 enrolled patients, 20 had a serious cardiac outcome within 72 hours of ED presentation. The derived LRs (and 95% confidence interval [CI]) were 0.5 (0.3–0.9) for TnI values <0.5 µg/L, 1.6 (0.4–6.5) for TnI values from 0.5 to 2.0 µg/L, 5.8 (1.7–19.5) for TnI values from >2.0 to 10.0 µg/L and 14.4 (4.8–42.9) for TnI values >10.0 µg/L. Conclusions: TnI values >2.0 µg/L are associated with an increased probability of serious cardiac outcomes within 72 hours. TnI values between 0.5 and 2.0 µg/L are weakly positive predictors. TnI values <0.5 µg/L have LRs in the range of 0.5 and thus are weakly negative predictors, not substantially decreasing the likelihood of serious cardiac outcomes, particularly in patients with a moderate or high pretest probability.

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An Online Tool for Nurse Triage to Evaluate Risk for Acute Coronary Syndrome at Emergency Department

Emergency Medicine International ◽

10.1155/2015/413047 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Yuwares Sittichanbuncha ◽

Patchaya Sanpha-asa ◽

Theerayut Thongkrau ◽

Chaiyapon Keeratikasikorn ◽

Noppadol Aekphachaisawat ◽

...

Keyword(s):

Emergency Department ◽

Acute Coronary Syndrome ◽

Chest Pain ◽

Tertiary Care ◽

Previous History ◽

Final Diagnosis ◽

Care Hospital ◽

Online Tool ◽

Coronary Syndrome ◽

Nurse Triage

Background. To differentiate acute coronary syndrome (ACS) from other causes in patients presenting with chest pain at the emergency department (ED) is crucial and can be performed by the nurse triage. We evaluated the effectiveness of the ED nurse triage for ACS of the tertiary care hospital.Methods. We retrospectively enrolled consecutive patients who were identified as ACS at risk patients by the ED nurse triage. Patients were categorized as ACS and non-ACS group by the final diagnosis. Multivariate logistic analysis was used to predict factors associated with ACS. An online model predictive of ACS for the ED nurse triage was constructed.Results. There were 175 patients who met the study criteria. Of those, 28 patients (16.0%) were diagnosed with ACS. Patients with diabetes, patients with previous history of CAD, and those who had at least one character of ACS chest pain were independently associated with having ACS by multivariate logistic regression. The adjusted odds ratios (95% confidence interval) were 4.220 (1.445, 12.327), 3.333 (1.040, 10.684), and 12.539 (3.876, 40.567), respectively.Conclusions. The effectiveness of the ED nurse triage for ACS was 16%. The online tool is available for the ED triage nurse to evaluate risk of ACS in individuals.

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Utility of a Bedside Pocket-Sized Ultrasound Device to Promptly Manage Abdominal Pain in the Emergency Department

Mediterranean Journal of Emergency Medicine & Acute Care ◽

10.52544/2642-7184(1)1001 ◽

2019 ◽

Vol 1 (1) ◽

pp. 13-21

Keyword(s):

Emergency Department ◽

Abdominal Pain ◽

Imaging Modality ◽

Low Cost ◽

Tertiary Care ◽

Area Under The Curve ◽

Final Diagnosis ◽

University Hospital ◽

Operating Characteristics ◽

Early Assessment

Introduction: Abdominal pain is a frequent reason for Emergency Department (ED) admission; it amounts for around 5–10% of all ED visits. Early assessment should focus on immediately distinguishing cases of acute abdomen that require urgent surgical intervention. The clinical localization of pain is crucial, suggesting an initial evaluation of the origin of the abdominal pain; however, imaging is often required for final diagnosis. Ultrasound (US) represents a rapid imaging modality that is readily available in the ED and does not involve radiation or contrast agent administration. A new generation of portable, battery-powered, low-cost, hand-carried ultrasound devices have become available recently; these devices can provide immediate diagnostic information in patients presenting with abdominal pain in ED.The aim of the study was to demonstrate the diagnostic usefulness of a bedside pocket-sized ultrasound (BPU) device (Vscan from General Electrics) in non-traumatic patients complaining of acute abdominal pain in a tertiary care university hospital in Italy. Methods: Patients with acute non-traumatic abdominal pain presenting in ED were prospectively enrolled and underwent physical examination, traditional imaging and BPU. Results: A total number of 230 patients with acute non-traumatic abdominal pain were enrolled. Overall agreement between routine standard imaging and BPU turned out to be equal for computed tomography (K=0.3) and traditional ultrasound (K=0.29). Receiver operating characteristics curve (ROC) analysis for diagnostic power of the BPU in comparison with traditional US showed an area under the curve of 0.65, sensitivity and specificity of 87.2% and 42.31% respectively. Conclusions: Emergency use of BPU in patients with non-traumatic abdominal pain demonstrated good diagnostic performance when compared to traditional imaging, with the potential advantage of reducing costs and delay in patient final disposition.

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Stroke patients presenting to the emergency department of a tertiary care hospital

Journal of Patan Academy of Health Sciences ◽

10.3126/jpahs.v8i2.30394 ◽

2021 ◽

Vol 8 (2) ◽

pp. 85-90

Author(s):

Suraj Rijal ◽

Sunil Adhikari ◽

Darlene Rose House

Keyword(s):

Emergency Department ◽

Demographic Data ◽

Tertiary Care ◽

Cross Sectional Study ◽

Common Disease ◽

Care Hospital ◽

Stroke Patients ◽

Cross Sectional ◽

Presenting Symptoms ◽

Ethical Approval

Introduction: Stroke is one of the most common causes of morbidity and mortality in Nepal. It is the 3rd most common cause of death worldwide. In Nepal Non-communicable diseases in Nepal(NCDs) states that stroke accounts for 42% of all deaths and is estimated to reach about 66.3% of all deaths by 2030. Method: A retrospective cross-sectional study of all stroke patients seen in Patan Hospital Emergency Department for a period of 1 y. Demographic data, presenting complaint, time of onset of symptoms, time presenting to the Emergency, patient’s risk factors for stroke, head CT findings (hemorrhagic or ischemic stroke) were analyzed descriptively. Ethical approval was taken. Result: Total 170 patients (96 males i.e.56.5% and 74 females i.e. 43.5%) were analyzed. 130(76.5%) were ischemic CVA and 40 (23.5%) were hemorrhagic CVA. The most common presenting symptoms was hemiparesis and speech changes. Conclusion: Stroke is a common disease seen in Nepal, with higher percentages of hemorrhagic stroke.

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Physical examination of psychiatric patients who presented at emergency department in a tertiary care hospital in Sultanate of Oman

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.284 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S335-S335

Author(s):

S. Alhuseini

Keyword(s):

Emergency Department ◽

Physical Examination ◽

Psychiatric Patients ◽

Demographic Data ◽

Tertiary Care ◽

Vital Signs ◽

University Hospital ◽

Psychiatric History ◽

Care Hospital ◽

Physical Assessment

ObjectiveTo examine the completeness of physical assessment of patients presenting with psychiatric problems to the emergency department (ED).MethodsThis was observational study based on a retrospective review of the medical records of patients who attended the ED of Sultan Qaboos university hospital and referred to the on-duty psychiatrist for assessment over a 12-month period. All patients aged 16 years and above, who presented to the ED with a psychiatric complaint were included in the study. A data collection sheet was designed to gather each patient's demographic data such as age and gender, past psychiatric history, nature of the presenting complaints, thoroughness of physical assessment, medications prescribed by the ED doctor prior to psychiatric assessment, and whether the patient was discharged, admitted to a psychiatry.ResultsA total of 202 patients met the inclusion criteria. The mean age of the patients was 34.2 years. Females represented 56% of the sample. The majority of the study group (60.4%) were patients with a documented past psychiatric history. Physical examination was conducted in the ED for 61.4% of the patients, while vital signs were recorded for 68.8% of them. Approximately, 31% of the patients required injectable psychotropic medications as tranquillizers in the ED. Patients with an isolated psychiatric complaint coupled with a documented past psychiatric history were more likely to be referred to the on-call psychiatrist without a physical examination by the ED doctors.ConclusionIn our institution, not all patients with psychiatric presentations had a complete physical examination by the ED doctors.Disclosure of interestThe author has not supplied his declaration of competing interest.

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Correlation of Pap smear and colposcopic findings in relation to histopathological findings among women attending a tertiary care hospital: a two year study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20192132 ◽

2019 ◽

Vol 8 (6) ◽

pp. 2163

Author(s):

Jyothi Gandavaram ◽

Bindu Reddy Pamulapati

Keyword(s):

Negative Predictive Value ◽

Predictive Value ◽

Pap Smear ◽

Demographic Data ◽

Tertiary Care ◽

Clinical History ◽

Premalignant Lesions ◽

Low Grade ◽

Care Hospital ◽

Cervical Lesions

Background: Cervical malignancy is ranked second among the malignancies in females with breast carcinoma the first. Screening for cervical cancer by conventional cytology and supported by colposcopy and histopathology can easily identify the premalignant lesions and also other non-invasive inflammatory lesions of the cervix. Objective of this study was to find the correlation of Pap smear, colposcopic findings and colposcopic guide biopsy in evaluation of cervical lesions in women and to analyze the various risk factorsMethods: A prospective study for two years was conducted by department of obstetrics among women aged from 20-60 years. Socio demographic data, clinical history and examination were done and findings noted. Pap smear, colposcopy and colposcopic guided biopsy was done and findings were noted and analyzed foe sensitivity, specificity and compared with Pap smear.Results: In present study sensitivity of Pap smear for detecting lesions above LSIL was 28%, specificity 99.32%, PPV was 93.47%, negative predictive value 76.21% and accuracy of Pap smear was 78%. The sensitivity of colposcopy in detection of low grade lesions and above came out to be 80.2%, specificity 82.14%, positive predictive value 66.78%, negative predictive value 86.78% and accuracy of colposcopy was 84.65%.The incidence of preinvasive lesions (LSIL and HSIL) was 33.6% with LSIL (19.2%) and HSIL (14.4%) and of invasive lesions was 9.6%.Conclusions: This study suggests that accuracy of detection of cervical abnormalities is higher when cytology, colposcopic biopsy and colposcopy are used complimentarily in diagnosis of cervical lesions. Colposcopy eliminates the need for repeated follow up as in Pap smear which has low sensitivity.

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Use of Delta Modified Search Out Severity (ΔM-SOS) Score for Early Detect Clinical Deterioration in Mechanically Ventilated Patients

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.02.11482 ◽

2021 ◽

Vol 104 (2) ◽

pp. 219-224

Keyword(s):

Predictive Value ◽

Tertiary Care ◽

Area Under The Curve ◽

Clinical Deterioration ◽

Early Warning Score ◽

Predictive Score ◽

Care Hospital ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Ventilated Patients

Objective: To validate the Delta Modified Search Out Severity (ΔM-SOS) score, the predictive score for clinical deterioration in mechanically ventilated patients. Materials and Methods: The prospective observational study included respiratory failure patients who were admitted to the respiratory care unit (RCU) of Hatyai Hospital, a tertiary care hospital, between August 2019 and February 2020. The ΔM-SOS score, score change from previous, and maximum M-SOS score were obtained. The main outcomes were clinical deterioration such as need for resuscitation, transfer to ICU, CPR, or dead, and 28-day mortality. Results: Of the 158 enrolled patients, 54 (34%) patients developed clinical deterioration. The 28-day mortality was 33.5%. The area under the curve of the ΔM-SOS score and M-SOS were 0.78 (95% CI 0.71 to 0.86, p<0.001) and 0.85 (95% CI 0.78 to 0.92, p<0.001), respectively. The ΔM-SOS score at cut off 3 had sensitivity 68.5%, specificity 79.8%, positive predictive value (PPV) 63.8%, and negative predictive value (NPV) 83.0%, while the M-SOS score at a cut off score of 6 exhibited sensitivity 74.1%, specificity 83.6%, PPV 70.2%, NPV 84.1%. Conclusion: The ΔM-SOS score had a fair to good performance as a predictive score for clinical deterioration in mechanically ventilated patients. Keywords: Validate, Early warning score, Delta, Detect, Clinical deterioration, Mechanically ventilated patients

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Midregional Pro-A-Type Natriuretic Peptide Measurements for Diagnosis of Acute Destabilized Heart Failure in Short-of-Breath Patients: Comparison with B-Type Natriuretic Peptide (BNP) and Amino-Terminal proBNP

Clinical Chemistry ◽

10.1373/clinchem.2005.065441 ◽

2006 ◽

Vol 52 (5) ◽

pp. 827-831 ◽

Cited By ~ 74

Author(s):

Alfons Gegenhuber ◽

Joachim Struck ◽

Werner Poelz ◽

Richard Pacher ◽

Nils G Morgenthaler ◽

...

Keyword(s):

Heart Failure ◽

Emergency Department ◽

Diagnostic Accuracy ◽

Natriuretic Peptide ◽

Tertiary Care ◽

Plasma Concentrations ◽

Area Under The Curve ◽

Diagnostic Value ◽

Care Hospital ◽

Amino Terminal

Abstract Background: The aim of the present study was to assess the utility of amino-terminal pro-A-type natriuretic peptide (NT-proANP) measurements for the emergency diagnosis of acute destabilized heart failure (HF), using a novel sandwich immunoassay covering midregional epitopes (MR-proANP). Methods: The retrospective analysis comprised 251 consecutive patients presenting to the emergency department of a tertiary care hospital with dyspnea as a chief complaint. The diagnosis of acute destabilized HF was based on the Framingham score for HF plus echocardiographic evidence of systolic or diastolic dysfunction. A commercially available immunoluminometric assay was used for measurement of MR-proANP plasma concentrations. Results: Median MR-proANP plasma concentrations were significantly higher in patients with dyspnea attributable to acute destabilized HF (338 pmol/L; n = 137) than in patients with dyspnea attributable to other reasons (98 pmol/L; n = 114; P <0.001). The area under the curve for MR-proANP was 0.876 (SE = 0.022; 95% confidence interval, 0.829–0.914), and the cutoff concentration with the highest diagnostic accuracy was 169 pmol/L (sensitivity, 89%; specificity, 76%; diagnostic accuracy, 83%). In the setting evaluated, diagnostic information obtained by MR-proANP measurements was similar to that obtained with B-type natriuretic peptide (BNP) and amino-terminal proBNP (NT-proBNP) measurements. Conclusions: MR-proANP measurements may be useful as an aid in the diagnosis of acute destabilized HF in short-of-breath patients presenting to an emergency department. The diagnostic value of MR-proANP appears to be comparable to that of BNP and NT-proBNP.

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SARS-CoV-2 Antigen Detection to Expand Testing Capacity for COVID-19: Results from a Hospital Emergency Department Testing Site

Diagnostics ◽

10.3390/diagnostics11071211 ◽

2021 ◽

Vol 11 (7) ◽

pp. 1211

Author(s):

Giulia Menchinelli ◽

Giulia De Angelis ◽

Margherita Cacaci ◽

Flora Marzia Liotti ◽

Marcello Candelli ◽

...

Keyword(s):

Emergency Department ◽

Predictive Value ◽

Tertiary Care ◽

Antigen Detection ◽

Care Hospital ◽

Hospital Emergency Department ◽

Rt Pcr ◽

Hospital Emergency ◽

Asymptomatic Patients ◽

Antigen Testing

Background: SARS-CoV-2 antigen detection has currently expanded the testing capacity for COVID-19, which yet relies on the SARS-CoV-2 RNA RT-PCR amplification. Objectives: To report on a COVID-19 testing algorithm from a tertiary care hospital emergency department (ED) that combines both antigen (performed on the ED) and RT-PCR (performed outside the ED) testing. Methods: Between December 2020 and January 2021, in a priori designated, spatially separated COVID-19 or non-COVID-19 ED areas, respectively, symptomatic or asymptomatic patients received SARS-CoV-2 antigen testing on nasopharyngeal swab samples. Antigen results were promptly accessible to guide subsequent, outside performed confirmatory (RT-PCR) testing. Results: Overall, 1083 (100%) of 1083 samples in the COVID-19 area and 1815 (49.4%) of 3670 samples in the non-COVID-19 area had antigen results that required confirmation by RT-PCR. Antigen positivity rates were 12.4% (134/1083) and 3.7% (66/1815), respectively. Compared to RT-PCR testing results, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of antigen testing were, respectively, 68.0%, 98.3%, 88.8%, and 94.1% in the COVID-19 area, and 41.9%, 97.3%, 27.3%, and 98.6% in non-COVID-19 area. Practically, RT-PCR tests were avoided in 50.6% (1855/3670) of non-COVID-19 area samples (all antigen negative) from patients who, otherwise, would have needed antigen result confirmation. Conclusions: Our algorithm had value to preserve RT-PCR from avoidable usage and, importantly, to save time, which translated into a timely RT-PCR result availability in the COVID-19 area.

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Impact of Positive Vancomycin-Resistant Enterococcus (VRE) Screen Result on Appropriateness of Definitive Antibiotic Therapy

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.829 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s263-s263

Author(s):

Jenna Reynolds ◽

Lynn Chan ◽

Raelene Trudeau ◽

Maria Teresa Seville

Keyword(s):

Antibiotic Therapy ◽

Predictive Value ◽

Hematologic Malignancy ◽

Tertiary Care ◽

Alternative Therapy ◽

Care Hospital ◽

Positive Screen ◽

Screen Result ◽

Definitive Therapy ◽

Vancomycin Resistant

Background: Vancomycin-resistant Enterococcus (VRE) screening has been utilized to identify colonized patients to prevent transmission. However, little is known about the utility of screening to guide antibiotic therapy. We assessed the appropriateness of definitive therapy in patients with a VRE screen and evaluate the predictive value of screening for the development of a VRE infection. Methods: In this retrospective study, we evaluated VRE screening of patients aged 18 years admitted between June 1, 2015, and May 31, 2018, to a 280-bed, academic, tertiary-care hospital. Rectal swabs were tested using Cepheid Xpert. Screening was performed routinely on admission for hematologic malignancy and liver transplantation patients. Only the first screen result was included for patients who had multiple VRE screens. The patient was classified as having a VRE infection if any Enterococcus isolates were vancomycin resistant. The primary outcome was appropriateness of antibiotic therapy in patients who had a VRE screen. Appropriateness of VRE-directed therapy was defined as therapy with linezolid or daptomycin for patients who had a positive VRE culture and an identifiable source of infection, or who had no clinical improvement on alternative therapy, or who had a documented β-lactam allergy. If appropriateness was unclear, 2 infectious diseases specialists determined appropriateness. Results: In total, 1,374 patients who had a rectal VRE screen met inclusion criteria. Of these, 1,053 (88%) had a negative screen. We detected no difference in the appropriateness of VRE-directed therapy between patients with a positive screen and those with a negative screen (59.3% vs 61.0%; P = .8657). The VRE screen had a sensitivity of 60% (95% CI, 43%–74%), specificity of 90% (95% CI, 88%–92%), positive predictive value of 18% (95% CI, 12%–25%), and negative predictive value of 98% (95% CI, 97%–99%) for VRE infection. Conclusions: Although VRE screening may have utility to detect colonization in high-risk patients, a positive VRE screen is of limited value in determining the need for VRE-directed therapy. Patients with a negative VRE screen have a low likelihood of developing a VRE infection, and a negative screen could be used to identify patients who may not require empiric coverage for VRE. Further research is needed to determine optimal utilization of VRE screening for prediction and treatment of VRE infections.Funding: NoneDisclosures: None

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