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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.
This global pandemic has severely strained healthcare resources, and shortages of various types, such as hospital beds, PPE, skilled healthcare workers, etc, have further complicated this global crisis. One of the proposed mechanisms for slowing the pandemic and limiting the number of infected individuals has been widespread community testing and isolating infected individuals. Unfortunately, in under-resourced countries, which account for the vast majority of the world, widespread testing has not been available, so those countries have resorted to testing only those individuals who are clinically symptomatic. This presents a particular problem since a significant number of carriers of the disease may be asymptomatic. Thus, early identification of both symptomatic patients, as well as asymptomatic carriers, remains a challenge and, if overcome, may help in slowing the pandemic significantly, leading further to the more effective management of SARS-CoV-2 on a global scale.
In this regard, the triage protocol for trauma patients has been particularly problematic. Before the SARS-CoV-2 outbreak, the trauma triage protocol was relatively uncomplicated and focused solely on treating life-threatening injuries in the shortest possible time. However, the SARS-CoV-2 outbreak and the presence of asymptomatic carriers poses a new and uncontested challenge regarding their triage and the protection of healthcare staff and other trauma patients. So far, the question of the potential triage of a trauma patient with an unknown SARS-CoV-2 status remains unanswered.
After the validation of the first version of DART (V.1.0), we engaged three statements with an identified low sensitivity and possible poor patient understanding and aimed to improve their wording by implementing expressions into our questionnaire which are frequently used in PILs. We were able to include a statement covering heart failure with an acceptable sensitivity, while observing some more false positive answers. The reliability of patients to answer questions about renal insufficiency remains a challenge: Disease awareness among patients with chronic kidney disease is generally low,24 28 29 hence making it difficult to retrieve information on from a self-assessment questionnaire. The low knowledge of chronic comorbidities like chronic kidney disease may show a lack of patient education within counselling and may therefore pose an additional task for pharmaceutical care. 2ff7e9595c
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