Feasibility and predictive performance of a triage system for cancer patients during the COVID-19 pandemic
Ce dossier présente un ensemble d'articles concernant la prise en charge des cancers durant la crise sanitaire liée au COVID-19
Résumé en anglais
Background : Triage procedures have been implemented to limit hospital access and minimize infection risk among cancer patients during the COVID‐19 outbreak. In the absence of prospective evidence, we aim to evaluate the predictive performance of a triage system in the oncological setting.
Patients and methods : This retrospective cohort study analyzes hospital admissions to the Oncology and Hematology Department of Udine, Italy, during the COVID‐19 pandemic (March 30th to April 30th, 2020). A total of 3923 triage procedures were performed, and data of 1363 individual patients were reviewed.
Results : A self‐report triage questionnaire identified 6% of triage‐positive procedures, with a sensitivity of 66.7% (95% 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 (OR 1.69, 95% CI: 1.13‐2.53, p=0.01), younger age (OR 1.52, 95% CI: 1.15‐2.01, p<0.01), and body temperature at admission ≥37°C (OR 9.52, 95% CI: 5.44‐16.6, p<0.0001) 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.
Conclusions : A self‐report questionnaire has a low positive predictive value to triage patients with cancer and suspected SARS‐CoV‐2 symptoms. Differential diagnosis with tumor‐ or treatment‐related symptoms is always required to avoid unnecessary 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 COVID‐19 outbreak. A questionnaire‐based triage has a low positive predictive value to triage patients with cancer and suspected 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 triage process's overall sensitivity, and widespread testing for SARS‐CoV‐2 infection should be implemented to identify asymptomatic carriers.
