Pragmatic recommendations for identification and triage of patients with COVID-19 in low- and middle-income countries
Effective identification and prognostication of severe COVID-19 patients presenting to healthcare facilities are essential to reducing morbidity and mortality. Low- and middle-income country (LMIC) facilities often suffer from restrictions in availability of human resources, laboratory testing, medi...
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| Formatua: | Journal article |
| Hizkuntza: | English |
| Argitaratua: |
American Society of Tropical Medicine and Hygiene
2021
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| _version_ | 1826279363485630464 |
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| author | Barros, LM Pigoga, JL Chea, S Hansoti, B Hirner, S Papali, A Rudd, KE Schultz, MJ Calvello Hynes, EJ |
| author2 | COVID-LMIC Task Force and the Mahidol-Oxford Research Unit (MORU) |
| author_facet | COVID-LMIC Task Force and the Mahidol-Oxford Research Unit (MORU) Barros, LM Pigoga, JL Chea, S Hansoti, B Hirner, S Papali, A Rudd, KE Schultz, MJ Calvello Hynes, EJ |
| author_sort | Barros, LM |
| collection | OXFORD |
| description | Effective identification and prognostication of severe COVID-19 patients presenting to healthcare facilities are essential to reducing morbidity and mortality. Low- and middle-income country (LMIC) facilities often suffer from restrictions in availability of human resources, laboratory testing, medications, and imaging during routine functioning, and such shortages may worsen during times of surge. Low- and middle-income country healthcare providers will need contextually appropriate tools to identify and triage potential COVID-19 patients. We report on a series of LMIC-appropriate recommendations and suggestions for screening and triage of COVID-19 patients in LMICs, based on a pragmatic, experience-based appraisal of existing literature. We recommend that all patients be screened upon first contact with the healthcare system using a locally approved questionnaire to identify individuals who have suspected or confirmed COVID-19. We suggest that primary screening tools used to identify individuals who have suspected or confirmed COVID-19 include a broad range of signs and symptoms based on standard case definitions of COVID-19 disease. We recommend that screening include endemic febrile illness per routine protocols upon presentation to a healthcare facility. We recommend that, following screening and implementation of appropriate universal source control measures, suspected COVID-19 patients be triaged with a triage tool appropriate for the setting. We recommend a standardized severity score based on the WHO COVID-19 disease definitions be assigned to all suspected and confirmed COVID-19 patients before their disposition from the emergency unit. We suggest against using diagnostic imaging to improve triage of reverse transcriptase (RT)-PCR–confirmed COVID-19 patients, unless a patient has worsening respiratory status. We suggest against the use of point-of-care lung ultrasound to improve triage of RT-PCR–confirmed COVID-19 patients. We suggest the use of diagnostic imaging to improve sensitivity of appropriate triage in suspected COVID-19 patients who are RT-PCR negative but have moderate to severe symptoms and are suspected of a false-negative RT-PCR with high risk of disease progression. We suggest the use of diagnostic imaging to improve sensitivity of appropriate triage in suspected COVID-19 patients with moderate or severe clinical features who are without access to RT-PCR testing for SARS-CoV-2. |
| first_indexed | 2024-03-06T23:57:35Z |
| format | Journal article |
| id | oxford-uuid:74c7cd0e-0c75-4c8f-8bc1-3e4cbee2ac13 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T23:57:35Z |
| publishDate | 2021 |
| publisher | American Society of Tropical Medicine and Hygiene |
| record_format | dspace |
| spelling | oxford-uuid:74c7cd0e-0c75-4c8f-8bc1-3e4cbee2ac132022-03-26T20:05:09ZPragmatic recommendations for identification and triage of patients with COVID-19 in low- and middle-income countriesJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:74c7cd0e-0c75-4c8f-8bc1-3e4cbee2ac13EnglishSymplectic ElementsAmerican Society of Tropical Medicine and Hygiene2021Barros, LMPigoga, JLChea, SHansoti, BHirner, SPapali, ARudd, KESchultz, MJCalvello Hynes, EJCOVID-LMIC Task Force and the Mahidol-Oxford Research Unit (MORU) Effective identification and prognostication of severe COVID-19 patients presenting to healthcare facilities are essential to reducing morbidity and mortality. Low- and middle-income country (LMIC) facilities often suffer from restrictions in availability of human resources, laboratory testing, medications, and imaging during routine functioning, and such shortages may worsen during times of surge. Low- and middle-income country healthcare providers will need contextually appropriate tools to identify and triage potential COVID-19 patients. We report on a series of LMIC-appropriate recommendations and suggestions for screening and triage of COVID-19 patients in LMICs, based on a pragmatic, experience-based appraisal of existing literature. We recommend that all patients be screened upon first contact with the healthcare system using a locally approved questionnaire to identify individuals who have suspected or confirmed COVID-19. We suggest that primary screening tools used to identify individuals who have suspected or confirmed COVID-19 include a broad range of signs and symptoms based on standard case definitions of COVID-19 disease. We recommend that screening include endemic febrile illness per routine protocols upon presentation to a healthcare facility. We recommend that, following screening and implementation of appropriate universal source control measures, suspected COVID-19 patients be triaged with a triage tool appropriate for the setting. We recommend a standardized severity score based on the WHO COVID-19 disease definitions be assigned to all suspected and confirmed COVID-19 patients before their disposition from the emergency unit. We suggest against using diagnostic imaging to improve triage of reverse transcriptase (RT)-PCR–confirmed COVID-19 patients, unless a patient has worsening respiratory status. We suggest against the use of point-of-care lung ultrasound to improve triage of RT-PCR–confirmed COVID-19 patients. We suggest the use of diagnostic imaging to improve sensitivity of appropriate triage in suspected COVID-19 patients who are RT-PCR negative but have moderate to severe symptoms and are suspected of a false-negative RT-PCR with high risk of disease progression. We suggest the use of diagnostic imaging to improve sensitivity of appropriate triage in suspected COVID-19 patients with moderate or severe clinical features who are without access to RT-PCR testing for SARS-CoV-2. |
| spellingShingle | Barros, LM Pigoga, JL Chea, S Hansoti, B Hirner, S Papali, A Rudd, KE Schultz, MJ Calvello Hynes, EJ Pragmatic recommendations for identification and triage of patients with COVID-19 in low- and middle-income countries |
| title | Pragmatic recommendations for identification and triage of patients with COVID-19 in low- and middle-income countries |
| title_full | Pragmatic recommendations for identification and triage of patients with COVID-19 in low- and middle-income countries |
| title_fullStr | Pragmatic recommendations for identification and triage of patients with COVID-19 in low- and middle-income countries |
| title_full_unstemmed | Pragmatic recommendations for identification and triage of patients with COVID-19 in low- and middle-income countries |
| title_short | Pragmatic recommendations for identification and triage of patients with COVID-19 in low- and middle-income countries |
| title_sort | pragmatic recommendations for identification and triage of patients with covid 19 in low and middle income countries |
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