Providing care in isolation while awaiting SARS-CoV-2 test results: Considering differential diagnoses and avoiding anchoring bias.

Autor:	Schmidt-Hellerau K; University of Cologne, Faculty of Medicine and University Hospital Cologne, Departement I of Internal Medicine, Cologne, Germany., Meyer-Schwickerath C; University of Cologne, Faculty of Medicine and University Hospital Cologne, Departement I of Internal Medicine, Cologne, Germany., Paul G; University of Cologne, Faculty of Medicine and University Hospital Cologne, Departement I of Internal Medicine, Cologne, Germany.; Katharinenhospital, Klinikum Stuttgart, Department of Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Stuttgart, Germany., Augustin M; University of Cologne, Faculty of Medicine and University Hospital Cologne, Departement I of Internal Medicine, Cologne, Germany.; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.; University of Cologne, Centre for Molecular Medicine Cologne, Cologne, Germany., Priesner V; University of Cologne, Faculty of Medicine and University Hospital Cologne, Departement I of Internal Medicine, Cologne, Germany.; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany., Rybniker J; University of Cologne, Faculty of Medicine and University Hospital Cologne, Departement I of Internal Medicine, Cologne, Germany.; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.; University of Cologne, Centre for Molecular Medicine Cologne, Cologne, Germany., Suárez I; University of Cologne, Faculty of Medicine and University Hospital Cologne, Departement I of Internal Medicine, Cologne, Germany.; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany., Hallek M; University of Cologne, Faculty of Medicine and University Hospital Cologne, Departement I of Internal Medicine, Cologne, Germany.; University of Cologne, Centre for Molecular Medicine Cologne, Cologne, Germany., Burst V; University of Cologne, Centre for Molecular Medicine Cologne, Cologne, Germany.; University of Cologne, Faculty of Medicine and Univeristy Hospital Cologne, Department II of Internal Medicine, Cologne, Germany.; University of Cologne, Faculty of Medicine and University Hospital Cologne, Emergency Department, Cologne, Germany., Kolibay F; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department for Clinical Affairs, Cologne, Germany., Fätkenheuer G; University of Cologne, Faculty of Medicine and University Hospital Cologne, Departement I of Internal Medicine, Cologne, Germany., Lehmann C; University of Cologne, Faculty of Medicine and University Hospital Cologne, Departement I of Internal Medicine, Cologne, Germany.; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.; University of Cologne, Centre for Molecular Medicine Cologne, Cologne, Germany., Jung N; University of Cologne, Faculty of Medicine and University Hospital Cologne, Departement I of Internal Medicine, Cologne, Germany.
Jazyk:	angličtina
Zdroj:	Medicine [Medicine (Baltimore)] 2021 Jul 30; Vol. 100 (30), pp. e26720.
DOI:	10.1097/MD.0000000000026720
Abstrakt:	Abstract: Isolation of confirmed or suspected coronavirus disease 2019 (COVID-19) cases is essential but, as symptoms of COVID-19 are non-specific and test results not immediately available, case identification at admission remains challenging. To inform optimization of triage algorithms, patient flow and patient care, we analyzed characteristics of patients admitted to an isolation ward, both severe acute respiratory syndrome coronavirus 2019 (SARS-CoV-2) positive patients and patients in which initial suspicion was not confirmed after appropriate testing.Data from patients with confirmed or suspected COVID-19 treated in an isolation unit were analyzed retrospectively. Symptoms, comorbidities and clinical findings were analyzed descriptively and associations between patient characteristics and final SARS-CoV-2 status were assessed using univariate regression.Eighty three patients (49 SARS-CoV-2 negative and 34 positive) were included in the final analysis. Of initially suspected COVID-19 cases, 59% proved to be SARS-CoV-2-negative. These patients had more comorbidities (Charlson Comorbidity Index median 5(interquartile range [IQR] 2.5, 7) vs 2.7(IQR 1, 4)), and higher proportion of active malignancy than patients with confirmed COVID-19 (47% vs 15%; P = .004), while immunosuppression was frequent in both patient groups (20% vs 21%; P = .984). Of SARS-CoV-2 negative patients, 31% were diagnosed with non-infectious diseases.A high proportion of patients (59%) triaged to the isolation unit were tested negative for SARS-CoV-2. Of these, many suffered from active malignancy (47%) and were immunosuppressed (20%). Non-infectious diseases were diagnosed in 31%, highlighting the need for appropriate patient flow, timely expert medical care including evaluation for differential diagnostics while providing isolation and ruling out of COVID-19 in these patients with complex underlying diseases. Competing Interests: The authors have no funding and conflicts of interests to disclose. (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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