Outpatient CT Centre for Emergency Triage of Patients with COVID-19: Local Experience from Saint Petersburg - European Medical Journal
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Outpatient CT Centre for Emergency Triage of Patients with COVID-19: Local Experience from Saint Petersburg

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2 Mins
Authors:
*Mikhail Cherkashin,1 Natalia Berezina,1 Alexey Nikolaev,1 Daria Kuplevatskaya,1 Vladimyr Kuplevatsky,1 Dmitry Lisovets,2 Alexey Boikov3
Disclosure:

The authors have declared no conflicts of interest.

Acknowledgements:

The authors would like to thank radiologists, radiographers, and emergency medical services staff for their daily hard work during the coronavirus disease (COVID-19) pandemic.

Citation
EMJ Radiol. ;2[1]:32-34. Abstract Review.

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.

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BACKGROUND AND AIM

Novel coronavirus disease (COVID-19) was characterised by a great influence on healthcare systems all over the world. During the first peak in the spring of 2020, the number of patients was devastating and clinical decisions were restricted by system capacity. Hospitals’ emergency departments were overloaded with patients with COVID-19, and ambulances spent many hours in line for patients’ hospitalisation. To improve healthcare system performance, some elements of triage should be implemented, as in mass casualty or disaster response. Chest CT is a highly sensitive imaging modality to diagnose COVID-19 pneumonia.1-3 At the start of the pandemic, with a lack of fast PCR results, some countries implemented CT-based triage at the hospital emergency department level.4,5

The aim of this work was to discuss the organisational principles of outpatient CT-based triage emergency centres.

Materials and METHODS

In April 2020, outpatient triage was started at the city level. Centres were equipped with CT, crash carts, vital monitors, defibrillators, and oxygen. There were consultant physicians, radiographers, and medical receptionists inside. Radiologists assessed images remotely using radiology information systems. Patients were admitted by ambulance to outpatient CT centres and assessed by consultant physicians (for symptoms, dyspnoea, and oxygen saturation levels). Based on chest CT results (severity of lung involvement) and clinical performance, decisions for hospitalisation were made. The triage algorithm is presented in Figure 1. Because of the hazardous environment, all staff were equipped with Level 2 personal protective equipment and strong infection control procedures were implemented.

Figure 1: Triage algorithm.
SpO2: oxygen saturation.

RESULTS

Between April–November 2020, 37,537 suspected and laboratory-tested patients with COVID-19 were triaged. Local radiology pneumonia severity classification (CT 1–4) was used for assessment: CT 1 with <25% of lungs involved; CT 2 with 25–50%; CT 3 with 50–75%; and CT 4 with ≥75% and more. Patients with CT 1–2 and good clinical performance were sent home for observation by ambulatory physicians. Patients with CT 3–4 and dyspnoea, oxygen saturation <94%, and comorbidities were admitted to hospital. During the 7 months, 21,986 patients with COVID-19 pneumonia were diagnosed. Overall, 5,532 moderate-to-severe and critical patients were hospitalised and 32,005 patients were referred for home treatment.

CONCLUSION

Based on the study results, the authors make several proposals.

Firstly, outpatient triage of patients with COVID-19 using CT is an acceptable strategy in a respiratory pandemic environment. Secondly, CT triage is a fast tool for clinical decision-making. Thirdly, infection control is a key point for medical staff safety. ■

References
Kalra MK et al. Chest CT practice and protocols for COVID-19 from radiation dose management perspective. Eur Radiol. 2020;30(12):6554-60. Raptis CA et al. Chest CT and coronavirus disease (COVID-19): a critical review of the literature to date. AJR Am J Roentgenol. 2020;215(4):839-42. Zhou H et al. Coronavirus disease 2019 (COVID-19): chest CT characteristics benefit to early disease recognition and patient classification-a single center experience. Ann Transl Med. 2020;8(11):679. Ducray V et al.; COVID-Outcomes-HCL Consortium. Chest CT for rapid triage of patients in multiple emergency departments during COVID-19 epidemic: experience report from a large French university hospital. Eur Radiol. 2021;31(2):795-803. Hermans JJR et al. Chest CT for triage during COVID-19 on the emergency department: myth or truth? Emerg Radiol. 2020;27(6):641-51.