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Barros LM, Pigoga JL, Chea S, et al. Pragmatic Recommendations for Identification and Triage of Patients with COVID-19 Disease in Low- and Middle-Income Countries. Am J Trop Med Hyg. 2021;doi: 10.4269/ajtmh.20-1064.
Barros, L. M., Pigoga, J. L., Chea, S., Hansoti, B., Hirner, S., Papali, A., Rudd, K. E., Schultz, M. J., Calvello Hynes, E. J., & For The Covid-Lmic Task Force And The Mahidol-Oxford Research Unit Moru Bangkok Thailand. (2021). Pragmatic Recommendations for Identification and Triage of Patients with COVID-19 Disease in Low- and Middle-Income Countries. The American journal of tropical medicine and hygiene, . https://doi.org/10.4269/ajtmh.20-1064
Barros, Lia M, et al. "Pragmatic Recommendations for Identification and Triage of Patients with COVID-19 Disease in Low- and Middle-Income Countries." The American journal of tropical medicine and hygiene vol. (2021). doi: https://doi.org/10.4269/ajtmh.20-1064
Barros LM, Pigoga JL, Chea S, Hansoti B, Hirner S, Papali A, Rudd KE, Schultz MJ, Calvello Hynes EJ, For The Covid-Lmic Task Force And The Mahidol-Oxford Research Unit Moru Bangkok Thailand. Pragmatic Recommendations for Identification and Triage of Patients with COVID-19 Disease in Low- and Middle-Income Countries. Am J Trop Med Hyg. 2021 Jan 06; doi: 10.4269/ajtmh.20-1064. Epub 2021 Jan 06. PMID: 33410394; PMCID: PMC7957239.
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Am J Trop Med Hyg. 2021 Jan 06; doi: 10.4269/ajtmh.20-1064. Epub 2021 Jan 06.

Pragmatic Recommendations for Identification and Triage of Patients with COVID-19 Disease in Low- and Middle-Income Countries.

The American journal of tropical medicine and hygiene

Lia M Barros, Jennifer L Pigoga, Sopheakmoniroth Chea, Bhakti Hansoti, Sarah Hirner, Alfred Papali, Kristina E Rudd, Marcus J Schultz, Emilie J Calvello Hynes, For The Covid-Lmic Task Force And The Mahidol-Oxford Research Unit Moru Bangkok Thailand

Affiliations

  1. Division of Cardiology, University of Washington Medical Center, Seattle, Washington.
  2. Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa.
  3. Department of Cardiology, Calmette Hospital, Phnom Penh, Cambodia.
  4. Department of Emergency Medicine, Johns Hopkins, Baltimore, Maryland.
  5. Department of Emergency Medicine, University of Colorado School of Medicine, Denver, Colorado.
  6. Division of Pulmonary and Critical Care Medicine, Atrium Health, Charlotte, North Carolina.
  7. Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
  8. Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom.
  9. Department of Intensive Care, Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Amsterdam, The Netherlands.
  10. Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.
  11. Department of Emergency Medicine, University of Colorado Hospital, Denver, Colorado.

PMID: 33410394 PMCID: PMC7957239 DOI: 10.4269/ajtmh.20-1064

Abstract

Effective identification and prognostication of severe COVID-19 patients presenting to healthcare facilities are essential to reducing morbidity and mortality. Low- and middle-income country (LMIC) facilities often suffer from restrictions in availability of human resources, laboratory testing, medications, and imaging during routine functioning, and such shortages may worsen during times of surge. Low- and middle-income country healthcare providers will need contextually appropriate tools to identify and triage potential COVID-19 patients. We report on a series of LMIC-appropriate recommendations and suggestions for screening and triage of COVID-19 patients in LMICs, based on a pragmatic, experience-based appraisal of existing literature. We recommend that all patients be screened upon first contact with the healthcare system using a locally approved questionnaire to identify individuals who have suspected or confirmed COVID-19. We suggest that primary screening tools used to identify individuals who have suspected or confirmed COVID-19 include a broad range of signs and symptoms based on standard case definitions of COVID-19 disease. We recommend that screening include endemic febrile illness per routine protocols upon presentation to a healthcare facility. We recommend that, following screening and implementation of appropriate universal source control measures, suspected COVID-19 patients be triaged with a triage tool appropriate for the setting. We recommend a standardized severity score based on the WHO COVID-19 disease definitions be assigned to all suspected and confirmed COVID-19 patients before their disposition from the emergency unit. We suggest against using diagnostic imaging to improve triage of reverse transcriptase (RT)-PCR-confirmed COVID-19 patients, unless a patient has worsening respiratory status. We suggest against the use of point-of-care lung ultrasound to improve triage of RT-PCR-confirmed COVID-19 patients. We suggest the use of diagnostic imaging to improve sensitivity of appropriate triage in suspected COVID-19 patients who are RT-PCR negative but have moderate to severe symptoms and are suspected of a false-negative RT-PCR with high risk of disease progression. We suggest the use of diagnostic imaging to improve sensitivity of appropriate triage in suspected COVID-19 patients with moderate or severe clinical features who are without access to RT-PCR testing for SARS-CoV-2.

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