Clinical characteristics of critically ill patients with 2019 novel coronavirus (COVID-19): do we need a new triage system?

Background: This expanded study presents the characteristic features of patients with novel Coronavirus 2019 (COVID-19) in intensive care units (ICUs). On the other hand, it has revealed an issue of triage on admission to ICUs for patients with COVID-19.

Methods: The critically ill patients’ characteristics, laboratory findings, treatment and outcomes data were recorded. All chest computed tomography (c-CT) images were reviewed by two experienced radiologists in chest imaging. Collected data were compared between the confirmed and suspected COVID-19 cases. Moreover, some detected parameters were evaluated via c-CT findings among suspected COVID-19 cases.

Results: The study population included 105 patients hospitalized in ICUs. Twenty-seven patients (25.7%) were confirmed COVID-19 through real-time reverse-transcription polymerase-chain-reaction (RT-PCR) assay, and 78 patients (74.3%) were suspected COVID-19. There was a significant difference between the confirmed COVID-19 and suspected COVID-19 patients in terms of PaO2/FiO2 ratio, APACHE II scoring system, the number of comorbidities. Interestingly, in suspected cases, mean PaO2/FiO2 ratio, APACHE II score, and the number of comorbidities were significantly higher in patients with typical c-CT findings for COVID-19 (P = 0.038, P = 0.034 and P = 0.020, respectively). Considering all three parameters, 33.3% of cases with typical CT findings could be reconsidered as highly probable COVID-19 infections. Moreover, 16.7% of the cases with atypical CT findings could be excluded and the unnecessary burden on ICUs could be reduced.

Conclusion: In many contagious diseases such as COVID-19, for a new triage system, specific characteristics, selected general physiological findings, and typical laboratory parameters may be standardized in addition to RT-PCR testing and c-CT examination.

Coronavirus; COVID-19; SARS CoV-2; Intensive care unit; Critical illness; Triage

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