Establishment of a Novel Triage System for SARS-CoV-2 among Trauma Victims in Trauma Centers with Limited Facilities
Hossein Abdolrahimzadeh Fard1, Salahaddin Mahmudi-Azer2, Sepideh Sefidbakht3, Pooya Iranpour3, Shahram Bolandparvaz1, Hamid Reza Abbasi4, Shahram Paydar1, Golnar Sabetian5, Mohamad Mahdi Mahmoudi1, Masoume Zare1, Leila Shayan1, Maryam Salimi6
1 Trauma Research Center, Department of Surgery, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
2 Pulmonary Research Group, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
3 Medical Imaging Research Center, Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
4 Education Development and Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
5 Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
6 Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
Citation: Fard HA, Mahmudi-Azer S, Sefidbakht S, Iranpour P, Salimi M et al (2021) Establishment of a Novel Triage System for SARS-CoV-2 among Trauma Victims in Trauma Centers with Limited Facilities. SciTech Central COVID-19.
Received: July 26, 2021 Accepted: August 05, 2021 Published: August 06, 2021
Objectives: The triage of trauma patients with potential COVID-19 remains a major challenge given that a significant number of patients may be asymptomatic or pre-symptomatic. This study aimed to compare the specificity and sensitivity of available triage systems for COVID-19 among trauma patients. Furthermore, it aimed to develop a novel triage system for SARS-CoV-2 detection among trauma patients in centers with limited resources.
Methods: All patients referred to our center from February to May 2020 were enrolled in this prospective study. We evaluated the SARS-CoV- 2 triage protocols from the WHO, the Iranian Ministry of Health and Medical Education (MOHME), and the European Centre for Disease Control and Prevention (ECDC) for their effectiveness in finding COVID-19 infected individuals among trauma patients. We then used these data to design a stepwise triage protocol to detect COVID-19 positive patients among trauma patients.
Results: According to our findings, the WHO protocol showed 100% specificity and 13.3% sensitivity. The MOHME protocol had 99% specificity and 23.3% sensitivity. While the ECDC protocol showed 93.3% sensitivity and 89.5% specificity, it did not prioritize patients based on traumatic injuries and unstable conditions. Our stepwise triage protocol, which prioritizes traumatic injuries, had 93.3% sensitivity and 90.3% specificity.
Conclusion: Our study shows that the triage protocols from the WHO, MOHME and ECDC are not best equipped to diagnose SARS-CoV-2 infected individuals among trauma patients. In our proposed stepwise triage system, patients are triaged according to their hemodynamic conditions, COVID-19 related clinical states, and COVID-19 related laboratory findings. Our triage model can lead to more accurate and resource-effective management of trauma patients with potential COVID-19 infection.
Keywords: COVID-19;RSNA criteria; Trauma; Pulmonary contusion
List of abbreviations
CT: Computed tomography; ICU: intensive care unit; COVID-19: coronavirus disease 2019
COPD: Chronic obstructive pulmonary disease, RSNA: The Radiological Society of North America; WHO: World Health Organization
rt-PCR: Reverse transcription polymerase chain reaction; GGO: Ground Glass Opacity; SIRS: Systemic Inflammatory Response Syndrome index; NLR: Lymphocyte to Neutrophil Ratio;
ISS: Injury Severity Score; AIS: Abbreviated Injury Score