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COVID-19 clinical risk assessment for guiding patient placement and diagnostic testing strategy on admission to hospital
  • +6
  • Nick K Jones,
  • Isobel Ramsay,
  • Elinor Moore,
  • Jonathan Fuld,
  • Chris Adcock,
  • Edward Banham-Hall,
  • Judith Babar,
  • Effrossyni Gkrania-Klotsas,
  • Hoi Ping Mok
Nick K Jones
Author Profile
Isobel Ramsay
Elinor Moore
Jonathan Fuld
Chris Adcock
Edward Banham-Hall
Judith Babar
Effrossyni Gkrania-Klotsas
Hoi Ping Mok

Abstract

Introduction: Without universal access to point-of-care SARS-CoV-2 testing, many hospitals rely on clinical judgement alone for identifying cases of COVID-19 early.
Methods: Cambridge University Hospitals NHS Foundation Trust introduced a traffic lights clinical judgement aid to the COVID-19 admissions unit in mid-March 2020. Ability to accurately predict COVID-19 was audited retrospectively across different stages of the epidemic.
Results:  One SARS-CoV-2 PCR positive patient (1/41, 2%) was misallocated to a ‘green’ (non-COVID-19) area during the first period of observation, and no patients (0/32, 0%) were mislabelled ‘green’ during the second period. 33 of 62 (53%) labelled ‘red’ (high risk) tested SARS-CoV-2 PCR positive during the first period, while 5 of 22 (23%) ‘red’ patients were PCR positive in the second.
Conclusion: COVID-19 clinical risk stratification on initial assessment effectively identifies non-COVID-19 patients. However, diagnosing COVID-19 is challenging and risk of overcalling COVID-19 should be recognised, especially when background incidence is low.
Key words: SARS-CoV-2, COVID-19, Coronavirus, Triage, Diagnostics, Infection Control