Triage tool for suspected COVID-19 patients in the emergency room: AIFELL score

Levenfus, Ian; Ullmann, Enrico; Battegay, Edouard; Schuurmans, Macé M.

doi:10.1016/j.bjid.2020.07.003

Acessibilidade / Reportar erro

Brasil

Brazilian Journal of Infectious Diseases

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Brief communications • Braz J Infect Dis 24 (5) • Sep-Oct 2020 • https://doi.org/10.1016/j.bjid.2020.07.003 copy

Triage tool for suspected COVID-19 patients in the emergency room: AIFELL score

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Clinical prediction scores support the assessment of patients in the emergency setting to determine the need for further diagnostic and therapeutic steps. During the current COVID-19 pandemic, physicians in emergency rooms (ER) of many hospitals have a considerably higher patient load and need to decide within a short time frame whom to hospitalize. Based on our clinical experiences in dealing with COVID-19 patients at the University Hospital in Zurich, we created a triage score with the acronym "AIFELL" consisting of clinical, radiological and laboratory findings.The score was then evaluated in a retrospective analysis of 122 consecutive patients with suspected COVID-19 from March until mid-April 2020. Descriptive statistics, Student's t-test, ANOVA and Scheffe's post-hoc analysis confirmed the diagnostic power of the score. The results suggest that the AIFELL score has potential as a triage tool in the ER setting intended to select probable COVID-19 cases for hospitalization in spontaneously presenting or referred patients with acute respiratory symptoms.

Keywords
COVID-19; SARS-CoV-2; Score; Emergency

AIFELL score by frontline experiences	Paraclinical measurements			Whole array of AIFELL components
AIFELL score by frontline experiences			ANOVA/Scheffe's post-hoc test			ANOVA/Scheffe's post hoc test
Σ of positive components = points	Mean ± SD	n	df = 116, F = 10.55, p < 0.0001	Mean ± SD	n	df = 116, F = 31.525, p < 0.0001
1	-0.54 ± 0.28	12	1 < 2; 1 < 3; 1 < ^* ***** p = .04. In only 86 of the 122 included cases, LDH values were determined. Smell and taste alterations were actively mentioned by the patients and not routinely asked by the physicians. Therefore, the number of positive cases is only 19. Patients without any positive components relating to the AIFELL score (Σ0, n = 5) were not included in statistical group comparisons. LDH, lactate dehydrogenase; CRP, C-reactive protein; SD, standard deviation. 4; 1 < ^* * p < .001; 5; 1 < ^ p < .01; 6	0.79 ± 0.93	12	1 < ^* * p < .001; 4; 1 < ^* * p < .001; 5; 1 < ^* * p < .001; 6; 1 < 2; 1 < 3
2	-0.21 ± 0.43	26	2 < 3; 2 < 4; 2 < ^* * p < .001; 5; 2 < 6	1.18 ± 0.55	26	2 < 3; 2 < ^* * p < .001; 4; 2 < ^* * p < .001; 5; 2 < ^* * p < .001; 6
3	-0.04 ± 0.32	16	3 < 5; 3 < 6	1.66 ± 0.67	16	3 < ^ p < .01; 5; 3 < ^* * p < .001; 6;
4	0.01 ± 0.65	31	4 < ^ p < .01; 5; 4 < 6	2.21 ± 0.93	31	4 < 5; 4 < ^* * p < .001; 6
5	0.52 ± 0.42	24		2.77 ± 0.83	24
6	0.30 ± 0.38	8		4.30 ± 0.38	8

Brazilian Society of Infectious Diseases Rua Augusto Viana, SN, 6º., 40110-060 Salvador - Bahia - Brazil, Telefax: (55 71) 3283-8172, Fax: (55 71) 3247-2756 - Salvador - BA - Brazil
E-mail: bjid@bjid.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] *Corresponding author. info@levenfus.com jan.levenfus@usz.ch

Consecutive patients with suspected COVID-19 admitted via the ER from March through mid-April 2020 (n = 122; 72 males, 50 females)
Nasopharyngeal qPCR result	SARS-CoV-2 positive (n = 70, age 60.6 years ± 14.2)			SARS-CoV-2 negative (n = 52, 57.9 years ± 17.9)
Components of the AIFELL score:Altered smell or taste (yes/no), Inflammation (CRP ≥ 30 mg/L), Infiltrates (yes/no), Fever (≥ 38º C), Elevated LDH (>400 U/L), Lymphocytopenia (absolute count < 1.45 G/L)
Diagnosis	COVID-19 Stage I (n = 10)	COVID-19 Stage IIa (n = 31)	COVID-19 Stage IIb (n = 29)	Other respiratory problems like exacerbated COPD, bronchial asthma, bacterial pneumonia, aspiration pneumonitis, other viral infections (influenza, metapneumovirus), cardiac failure
Mean AIFELL score	1.8 ± 0.8	4.6 ± 0.8		2.2 ± 1.1
Mean AIFELL score	4.19 ± 1.28			2.2 ± 1.1
Total number n AIFELL positive (4-6 points)	0	29 (93.5%)	29 (100%)	5 (9.6%)
Total number n AIFELL negative (0 - 3 points)	10 (100%)	2 (6.5%)	0	47 (90.4%)