tetano
Editor, Senior Moderator
PM R
. 2020 Jul 23.
doi: 10.1002/pmrj.12454. Online ahead of print.
Screening testing for SARS-CoV-2 upon admission to rehabilitation hospitals in a high COVID-19 prevalence community
Steven C Kirshblum[SUP] 1 2 3 [/SUP], Gabrielle DeLauter[SUP] 3 [/SUP], Maeve C Lopreiato[SUP] 1 2 [/SUP], Bruce Pomeranz[SUP] 1 2 3 [/SUP], Amanda Dawson[SUP] 3 [/SUP], Samuel Hammerman[SUP] 3 [/SUP], Bruce M Gans[SUP] 1 2 3 [/SUP]
Affiliations
Abstract
Introduction: While planning for the care of COVID-19 patients during the pandemic crisis has dominated the focus of leaders of inpatient rehabilitation facilities (IRF), patients with injuries/ illnesses unrelated to COVID-19 continue to need inpatient rehabilitation admission. To maintain a safe environment for all patients and staff, we established an admission screening plan of testing for SARS-CoV-2 to determine the presence of asymptomatic patients who were infected with the virus upon admission.
Objective: To determine the prevalence of patients who test positive for SARS-CoV-2 but were presumed to be COVID-19 negative at the time of admission to IRF in New Jersey.
Design: Retrospective analysis of SARS-CoV-2 testing results.
Setting: Four freestanding IRFs in New Jersey operated as one system.
Patients: All (N=103) patients sequentially admitted from April 4 -27, 2020 with no symptoms or evidence of COVID-19 disease at the time of transfer from the acute hospital.
Interventions: Specimens were collected for SARS-CoV-2 analysis at the time of admission to the IRF and patients were monitored for subsequent symptom development over the next 14 days.
Main outcome measures: Results of SARS-CoV-2 testing upon admission and evidence of development of clinical signs or symptoms of COVID-19.
Results: Seven asymptomatic persons (6.8% of admissions) without clinical signs/symptoms of COVID-19 tested positive on admission. Of these, five developed symptoms of COVID-19, with a mean onset of 3.2 (range of 2-5) days. Five additional patients became symptomatic and tested positive within the next 3-10 days (mean of 5.2 days). Overall, 11.6% of admissions (12/103) had a positive test within 14 days of admission.
Conclusions: Admission testing to post-acute centers for SARS-CoV-2 can help identify pre-symptomatic or asymptomatic individuals, especially in areas where COVID-19 is prevalent. Negative results however, do not preclude COVID-19 and should not be used as the sole basis for patient management decisions. This article is protected by copyright. All rights reserved.
Keywords: COVID-19; Inpatient rehabilitation; Outcomes research; Quality Improvement and Patient Safety; coronavirus, pandemic.
. 2020 Jul 23.
doi: 10.1002/pmrj.12454. Online ahead of print.
Screening testing for SARS-CoV-2 upon admission to rehabilitation hospitals in a high COVID-19 prevalence community
Steven C Kirshblum[SUP] 1 2 3 [/SUP], Gabrielle DeLauter[SUP] 3 [/SUP], Maeve C Lopreiato[SUP] 1 2 [/SUP], Bruce Pomeranz[SUP] 1 2 3 [/SUP], Amanda Dawson[SUP] 3 [/SUP], Samuel Hammerman[SUP] 3 [/SUP], Bruce M Gans[SUP] 1 2 3 [/SUP]
Affiliations
- PMID: 32700434
- DOI: 10.1002/pmrj.12454
Abstract
Introduction: While planning for the care of COVID-19 patients during the pandemic crisis has dominated the focus of leaders of inpatient rehabilitation facilities (IRF), patients with injuries/ illnesses unrelated to COVID-19 continue to need inpatient rehabilitation admission. To maintain a safe environment for all patients and staff, we established an admission screening plan of testing for SARS-CoV-2 to determine the presence of asymptomatic patients who were infected with the virus upon admission.
Objective: To determine the prevalence of patients who test positive for SARS-CoV-2 but were presumed to be COVID-19 negative at the time of admission to IRF in New Jersey.
Design: Retrospective analysis of SARS-CoV-2 testing results.
Setting: Four freestanding IRFs in New Jersey operated as one system.
Patients: All (N=103) patients sequentially admitted from April 4 -27, 2020 with no symptoms or evidence of COVID-19 disease at the time of transfer from the acute hospital.
Interventions: Specimens were collected for SARS-CoV-2 analysis at the time of admission to the IRF and patients were monitored for subsequent symptom development over the next 14 days.
Main outcome measures: Results of SARS-CoV-2 testing upon admission and evidence of development of clinical signs or symptoms of COVID-19.
Results: Seven asymptomatic persons (6.8% of admissions) without clinical signs/symptoms of COVID-19 tested positive on admission. Of these, five developed symptoms of COVID-19, with a mean onset of 3.2 (range of 2-5) days. Five additional patients became symptomatic and tested positive within the next 3-10 days (mean of 5.2 days). Overall, 11.6% of admissions (12/103) had a positive test within 14 days of admission.
Conclusions: Admission testing to post-acute centers for SARS-CoV-2 can help identify pre-symptomatic or asymptomatic individuals, especially in areas where COVID-19 is prevalent. Negative results however, do not preclude COVID-19 and should not be used as the sole basis for patient management decisions. This article is protected by copyright. All rights reserved.
Keywords: COVID-19; Inpatient rehabilitation; Outcomes research; Quality Improvement and Patient Safety; coronavirus, pandemic.