Simple and Effective Primary Assessment of Emergency Patients in a COVID-19 Outbreak Area: A Retrospective, Observational Study

Abstract

Background

The rapid spread of COVID-19 has expanded into a pandemic, for which the main containment strategies to reduce transmission are social distancing and isolation of ill persons. Thousands of medical staff have been infected worldwide. Coronavirus testing kits have been in short supply, and early diagnostic reagents did not have high sensitivity. The aim of this study was to describe the characteristics of patients requiring emergency surgery in a COVID-19 outbreak area.

Methods

We assessed medical data regarding all patients who underwent emergency surgery at the main campus of Wuhan Union Hospital from January 23, 2020, to February 15, 2020. We classified patients based on suspicion of COVID-19 infection (suspected vs not suspected) before they were admitted to the operating room. We used descriptive statistics to analyze the data. Outcomes included the incidence of confirmed COVID-19 infection and length of stay, which were followed until March 25, 2020.

Results

Among the 88 emergency patients included in this study, the mean age was 37 years. Twenty-five patients presented with abnormalities observed on chest CT scans and 16 presented with fever. The median wait time for surgery was one day. The median preparation time and median time until short orientation memory concentration test (SOMCT) recovery from anesthesia were 44.0 min and 23.0 min, respectively. The median postoperative length of stay was five days. Compared with patients not suspected of COVID-19 infection, six patients were confirmed to be infected with COVID-19 in the suspected group. No health care workers were infected during this study period.

Conclusion

Simple identification using temperature screening of patients, respiratory symptoms, and chest CT scans before being admitted for emergency surgery was rapid and effective. Shortened contact times might reduce the risk of infection. Additional investigations with larger samples and improved designs are needed to confirm these observations.

Keywords:

• COVID-19
• emergency
• cross-infection

Acknowledgments

The authors thank all health care workers to fight the epidemic outbreak for their courageous work.

Abbreviations

COVID-19, coronavirus disease-2019; qRT-PCR, quantitative real-time polymerase chain reaction; SD, standard deviation; ASA, American Society of Anesthesiologists; CT, computed tomography; SOMCT, short orientation memory concentration test; CHDs, congenital heart disease; CRP, C-reactive protein; hs-CRP, high-sensitivity C-reactive protein; IQR, interquartile range; GA, general anesthesia; ICU, intensive care unit.

Ethics Approval and Consent to Participate

Tongji Medical College Ethics Committee approved our observational study. We were compliant with the Declaration of Helsinki, with respect to ethical treatment of patients in this clinical retrospective study. This study used only anonymized data and the rapid emergence of this infectious disease, written informed consent was waived.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

Funded by the Natural Science Foundation of Hubei Province ZRMS2019000029. The source of funding of the authors playing no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.