SARS-CoV-2 management in Emergency Department: risk stratification and care setting identification proposal based on first pandemic wave in Pisa University Hospital
SARS-CoV-2 management in Emergency Department: risk stratification and care setting identification proposal based on first pandemic wave in Pisa University Hospital Background: COVID-19 patients require early treatment and admission to an appropriate care setting, considering possible rapid and u...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
PAGEPress Publications
2021-12-01
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| Series: | Emergency Care Journal |
| Subjects: | |
| Online Access: | https://pagepressjournals.org/index.php/ecj/article/view/9859 |
| _version_ | 1828489705529802752 |
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| author | Greta Barbieri Alessandro Cipriano Stella Carrara Stefano Spinelli Francesco Cinotti Francesca Foltran Matteo Filippi Ferruccio Aquilini Michele Tonerini Massimo Santini Paolo Malacarne Lorenzo Ghiadoni |
| author_facet | Greta Barbieri Alessandro Cipriano Stella Carrara Stefano Spinelli Francesco Cinotti Francesca Foltran Matteo Filippi Ferruccio Aquilini Michele Tonerini Massimo Santini Paolo Malacarne Lorenzo Ghiadoni |
| author_sort | Greta Barbieri |
| collection | DOAJ |
| description | SARS-CoV-2 management in Emergency Department: risk stratification and care setting identification proposal based on first pandemic wave in Pisa University Hospital
Background: COVID-19 patients require early treatment and admission to an appropriate care setting, considering possible rapid and unpredictable to Severe Acute Respiratory Syndrome.
Objective: A flow-chart was developed by a multidisciplinary team of Emergency Department (ED) clinicians, intensivists and radiologists aiming to provide tools for disease severity stratification, appropriate ventilation strategy and hospitalization setting identification.
Methods: We conducted a retrospective application of our model on 313 hospitalized patients at Pisa University Hospital including 222 patients admitted to ED for respiratory failure between March and April 2020. Risk stratification score was based on respiratory and chest imaging parameters, while management strategy on comorbidities and age.
Results: Age, comorbidities, clinical respiratory and arterial blood gas parameters, semi-quantitative chest computed tomography score were significant predictors of mortality (p<0,05). Mortality rate was higher in patients treated in intensive care units (26,5%) and undergoing endo-tracheal intubation (32,7%), compared to medical area (21,3%). We verified a good concordance (81,7%) between the proposed model and actual evaluation in ED. Outcomes analysis of subgroups of patients homogeneous for baseline features allowed to verify safety of our model: in non-elderly and/or non-comorbid patients (15% mortality) our scheme overestimates the risk in 30% of cases, but it suggests non-intensive management in patients with reduced functional reserve, elderly and with comorbidities (50% mortality).
Conclusion: Correct management of respiratory failure COVID-19 patients is crucial in this unexpected pandemic. Our flow-chart, despite retrospectively application in small sample, could represents a valid and safe proposal for evaluation in ED. |
| first_indexed | 2024-12-11T10:30:43Z |
| format | Article |
| id | doaj.art-153548c5ccd04d64a720eea8b8baeb8f |
| institution | Directory Open Access Journal |
| issn | 1826-9826 2282-2054 |
| language | English |
| last_indexed | 2024-12-11T10:30:43Z |
| publishDate | 2021-12-01 |
| publisher | PAGEPress Publications |
| record_format | Article |
| series | Emergency Care Journal |
| spelling | doaj.art-153548c5ccd04d64a720eea8b8baeb8f2022-12-22T01:10:56ZengPAGEPress PublicationsEmergency Care Journal1826-98262282-20542021-12-0117410.4081/ecj.2021.9859SARS-CoV-2 management in Emergency Department: risk stratification and care setting identification proposal based on first pandemic wave in Pisa University HospitalGreta Barbieri0Alessandro Cipriano1Stella Carrara2Stefano Spinelli3Francesco Cinotti4Francesca Foltran5Matteo Filippi6Ferruccio Aquilini7Michele Tonerini8Massimo Santini9Paolo Malacarne10Lorenzo Ghiadoni11Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa; Emergency Medicine Department, Pisa University Hospital, PisaEmergency Medicine Department, Pisa University Hospital, PisaDepartment of Anaesthesia and Critical Care Medicine, Pisa University Hospital, PisaEmergency Medicine Department, Pisa University Hospital, ItalyEmergency Medicine Department, Pisa University Hospital, PisaMedical Directional Department, Pisa University Hospital, PisaMedical Directional Department, Pisa University Hospital, PisaUniversity Hospital of PisaDepartment of Emergency Radiology, Pisa University Hospital, PisaEmergency Medicine Department, Pisa University Hospital, PisaDepartment of Anaesthesia and Critical Care Medicine, Pisa University Hospital, PisaEmergency Medicine Department, Pisa University Hospital, Pisa; Department of Clinical and Experimental Medicine, University of PisaSARS-CoV-2 management in Emergency Department: risk stratification and care setting identification proposal based on first pandemic wave in Pisa University Hospital Background: COVID-19 patients require early treatment and admission to an appropriate care setting, considering possible rapid and unpredictable to Severe Acute Respiratory Syndrome. Objective: A flow-chart was developed by a multidisciplinary team of Emergency Department (ED) clinicians, intensivists and radiologists aiming to provide tools for disease severity stratification, appropriate ventilation strategy and hospitalization setting identification. Methods: We conducted a retrospective application of our model on 313 hospitalized patients at Pisa University Hospital including 222 patients admitted to ED for respiratory failure between March and April 2020. Risk stratification score was based on respiratory and chest imaging parameters, while management strategy on comorbidities and age. Results: Age, comorbidities, clinical respiratory and arterial blood gas parameters, semi-quantitative chest computed tomography score were significant predictors of mortality (p<0,05). Mortality rate was higher in patients treated in intensive care units (26,5%) and undergoing endo-tracheal intubation (32,7%), compared to medical area (21,3%). We verified a good concordance (81,7%) between the proposed model and actual evaluation in ED. Outcomes analysis of subgroups of patients homogeneous for baseline features allowed to verify safety of our model: in non-elderly and/or non-comorbid patients (15% mortality) our scheme overestimates the risk in 30% of cases, but it suggests non-intensive management in patients with reduced functional reserve, elderly and with comorbidities (50% mortality). Conclusion: Correct management of respiratory failure COVID-19 patients is crucial in this unexpected pandemic. Our flow-chart, despite retrospectively application in small sample, could represents a valid and safe proposal for evaluation in ED.https://pagepressjournals.org/index.php/ecj/article/view/9859COVID-19ventilationpneumoniaemergency departmentmanagement strategy |
| spellingShingle | Greta Barbieri Alessandro Cipriano Stella Carrara Stefano Spinelli Francesco Cinotti Francesca Foltran Matteo Filippi Ferruccio Aquilini Michele Tonerini Massimo Santini Paolo Malacarne Lorenzo Ghiadoni SARS-CoV-2 management in Emergency Department: risk stratification and care setting identification proposal based on first pandemic wave in Pisa University Hospital Emergency Care Journal COVID-19 ventilation pneumonia emergency department management strategy |
| title | SARS-CoV-2 management in Emergency Department: risk stratification and care setting identification proposal based on first pandemic wave in Pisa University Hospital |
| title_full | SARS-CoV-2 management in Emergency Department: risk stratification and care setting identification proposal based on first pandemic wave in Pisa University Hospital |
| title_fullStr | SARS-CoV-2 management in Emergency Department: risk stratification and care setting identification proposal based on first pandemic wave in Pisa University Hospital |
| title_full_unstemmed | SARS-CoV-2 management in Emergency Department: risk stratification and care setting identification proposal based on first pandemic wave in Pisa University Hospital |
| title_short | SARS-CoV-2 management in Emergency Department: risk stratification and care setting identification proposal based on first pandemic wave in Pisa University Hospital |
| title_sort | sars cov 2 management in emergency department risk stratification and care setting identification proposal based on first pandemic wave in pisa university hospital |
| topic | COVID-19 ventilation pneumonia emergency department management strategy |
| url | https://pagepressjournals.org/index.php/ecj/article/view/9859 |
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