Feasibility and Predictive Performance of a Triage System for Patients with Cancer During the COVID-19 Pandemic

The oncologist

article

Gianpiero Fasola¹  Chiara Comuzzi²  Anna Candoni²  Alessandra Sperotto²  Renato Fanin²  Giacomo Pelizzari¹  Diego Zara¹  Giada Targato¹  Giuseppe Petruzzellis²  Alessandro Marco Minisini¹  Alessandra Bin¹  Raffaela Donato¹  Mauro Mansutti¹ 

[1] Department of Oncology, Santa Maria della Misericordia Hospital;Department of Hematology, Santa Maria della Misericordia Hospital;Department of Medicine, University of Udine

关键词: COVID-19;    SARS-CoV-2;    Cancer;    Containment measures;    Triage;   

DOI  :  10.1002/onco.13706

学科分类：地质学

来源: AlphaMed Press Incorporated

【 摘 要 】

Background Triage procedures have been implemented to limit hospital access and minimize infection risk among patients with cancer during the coronavirus disease (COVID-19) outbreak. In the absence of prospective evidence, we aimed to evaluate the predictive performance of a triage system in the oncological setting. Materials and Methods This retrospective cohort study analyzes hospital admissions to the oncology and hematology department of Udine, Italy, during the COVID-19 pandemic (March 30 to April 30, 2020). A total of 3,923 triage procedures were performed, and data of 1,363 individual patients were reviewed. Results A self-report triage questionnaire identified 6% of triage-positive procedures, with a sensitivity of 66.7% (95% confidence interval [CI], 43.0%–85.4%), a specificity of 94.3% (95% CI, 93.5%–95.0%), and a positive predictive value of 5.9% (95% CI, 4.3%–8.0%) for the identification of patients who were not admitted to the hospital after medical review. Patients with thoracic cancer (odds ratio [OR], 1.69; 95% CI, 1.13–2.53, p = .01), younger age (OR, 1.52; 95% CI, 1.15–2.01, p < .01), and body temperature at admission ≥37°C (OR, 9.52; 95% CI, 5.44–16.6, p < .0001) had increased risk of positive triage. Direct hospital access was warranted to 93.5% of cases, a further 6% was accepted after medical evaluation, whereas 0.5% was refused at admission. Conclusion A self-report questionnaire has a low positive predictive value to triage patients with cancer and suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) symptoms. Differential diagnosis with tumor- or treatment-related symptoms is always required to avoid unnecessary treatment delays. Body temperature measurement improves the triage process's overall sensitivity, and widespread SARS-CoV-2 testing should be implemented to identify asymptomatic carriers. Implications for Practice This is the first study to provide data on the predictive performance of a triage system in the oncological setting during the coronavirus disease outbreak. A questionnaire-based triage has a low positive predictive value to triage patients with cancer and suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) symptoms, and a differential diagnosis with tumor- or treatment-related symptoms is mandatory to avoid unnecessary treatment delays. Consequently, adequate recourses should be reallocated for a triage implementation in the oncological setting. Of note, body temperature measurement improves the overall sensitivity of the triage process, and widespread testing for SARS-CoV-2 infection should be implemented to identify asymptomatic carriers.

【 授权许可】

CC BY|CC BY-NC