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Identification and Triage

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Improving Identification and Triage of Patients with COVID-19
Lia M. Barros, DNP, ARNP
Disclosure
• No financial disclosures
• Author for the Pragmatic
Guidelines for
Identification and Triage
of Patients with COVID19 in Low to Middle
Income Countries
Copyright @2021 ESICM
Learning Objectives
• Understand the importance of identifying and triaging patients
with COVID-19
• Name the readily available screening and secondary screening
tools that can help identify patients with possible or confirmed
cases of COVID-19.
• List key features of an appropriate triage severity of illness scoring
system to determine appropriate level of care for COVID-19
patients in Low to Middle Income Countries (LMIC)
• Identify which diagnostic modalities can be used to risk stratify
patients with suspected or confirmed COVID-19 and when they
are clinically indicated.
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Why Identification
and Triage Matter
• Essential to managing the surge of
healthcare needs
• Decreases mortality and morbidity
• Reduction in the use of PPE
• Preserves healthcare worker resource
• Slows the spread of disease
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Lowers In Hospital Transmission
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Information Gathering and Assessment
Strategy
1. Screening: serves primarily as a mechanism of isolating patients
who are potentially positive cases of COVID-19 to reduce the
spread of the virus within facilities
2. Triage: a systematic method of sorting patients by the severity of
their clinical syndrome and matching patients with healthcare
resources, regardless of specific disease state
3. Severity Scoring: a value to prognosticate patients, although it is
applied to a specific disease state it is used to risk stratify
patients and identify those likely to have poor outcomes
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WHO Guidelines
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Screening Tools
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Validated Screening Tools Available
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Isolation
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Secondary Screening
Secondary Screening
SUSPECTED
PROBABLE
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CONFIRMED
Triage Severity of Illness Score
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Prediction of In Hospital Mortality
World Health Organization, 2020. Operational
Considerations for Case Management of COVID-19 in
Health Facility and Community Interim
Guidance. Geneva, Switzerland: WHO.
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REMS Severity Score and Oxygen
Saturation
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Risk Stratification Strategy and Diagnostic
Modalities
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Take Home Message
• Triage is essential to reducing morbidity and mortality.
• All patients should be screened for COVID-19 upon first contact with
the healthcare system using a locally approved questionnaire with a
broad range of signs and symptoms based on standard case
definitions of COVID-19 disease.
• Once following screening and implementation of appropriate universal
source control measures, suspected and confirmed COVID-19 patients
should be triaged with a triage tool that uses standardized severity
score based on the WHO COVID-19 disease definitions.
• Diagnostic imaging and lung ultrasound should not be used to improve
triage unless a patient is having worsening respiratory or has moderate
to severe clinical features of disease and without access to RT-PCR
testing for SARC-CoV-2
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Acknowledgements
My deepest appreciate and heart felt thank you to my
incredible coauthors:
Jennifer Pigoga, Sopheakmoniroth Chea, Bhakti Hansoti, Sarah
Hirner, Alfred Papali, Kristina Rudd, Marcus Schultz, and Emilie
Calvello Hynes
And no words can express my gratitude for my colleagues and
friends working to stop the spread of COVID-19 in Cambodia,
Vietnam, and Nepal. You are truly an inspiration.
Copyright @2021 ESICM
References
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and Testing for COVID-19 Infection from Classification and Regression Trees (CART) Analysis. medRxiv: 2020.05.11.20097980.
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X, Huang G, 2020. A quickly, effectively screening process of novel corona virus disease 2019 (COVID-19) in children in Shanghai, China.
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4. Organization WH, 2020. Operational considerations for case management of COVID-19 in health facility and community Interim
guidance.
5. 7 August 2020. World Health Organization COVID-19: Case Definitions. Case Definitions updated in public health surveillance for COVID19.
6. Organization WH, 2020. Clinical management of COVID-19 Interim guidance.
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Patients Hospitalized at a Large US Academic Medical Center. JAMA network open 3: e2020498-e2020498.
8. Fan G, Tu C, Zhou F, Liu Z, Wang Y, Song B, Gu X, Wang Y, Wei Y, Li H, Wu X, Xu J, Tu S, Zhang Y, Wu W, Cao B, 2020. Comparison of severity
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Respiratory Medicine 8: e22.
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Thank you
Lia M Barros
[email protected]
Copyright @2021 ESICM
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