Risk stratification of emergencies during the COVID-19 pandemic within the emergency department

Abstract

Background: The COVID-19 pandemic represents a complex challenge for medical staff within emergency departments (ED) of hospitals at all care levels. Beside regular emergency care, rapid detection and isolation of COVID-19 cases are obligatory for prevention of internal viral transmission and efficient medical staff protection. Methods: In this study a model of risk stratification for suspected SARS-CoV‑2 and COVID-19 cases was developed on the basis of epidemiologic criteria of the Robert-Koch Institute including five risk categories (RC). The model was implemented in a hospital of basic and regular care level. By combination of risk categories with specific isolation, hygienic and personal protection procedures all areas of the ED were restructured. In a retrospective study all inpatient cases (n = 491) were re-evaluated during a 4-week interval (26 March–26 April 2020). Results: In the study population 25 SARS-CoV‑2 positive cases (5.2%) were identified. These cases were categorized according to the risk stratification model as follows: RC I—confirmed SARS-CoV‑2 infection 36% (n = 9), RC II—reasonable suspected cases 32% (n = 8), RC III—differential diagnostic cases 12% (n = 3), RC IV—low probability 8% (n = 2) and RC V—no evidence 12% (n = 3). No viral transmission was detected during the whole period within medical staff and patients of the ED. Conclusions: Introduction of COVID-19 risk categories within the ED permits central control of important hygienic processes with respect to SARS-CoV‑2 infection probability. By continuous re-evaluation of case definitions local outbreaks can be used to adapt criteria within the risk categories. Risk stratification of COVID-19 cases allows for a strict separation of COVID-19 and non-COVID-19 emergencies and thus ensures effective infection prevention of medical staff and patients.