Effectiveness of the CLUE protocol in COVID-19 triage

Hüseyin Acar; Adnan Yamanoğlu; Cüneyt Arıkan; Serkan Bilgin; Pınar Yeşim Akyol; Ahmet Kayalı; Zeynep Karakaya

doi:10.17826/cumj.1086062

TR EN

COVID-19 triajında CLUE protokolünün etkinliği

Öz

Amaç: Bu çalışmanın amacı, CLUE protokolünün COVID-19 triajındaki etkinliğini değerlendirmektir Gereç ve Yöntem: Bu prospektif, gözlemsel çalışmaya nefes darlığı nedeniyle acil servise başvuran oksijen saturasyonu %95' in altında olan ve revers transkripsiyon polimeraz zincir reaksiyonu (RT-PCR) testleri ile COVID-19 tanısı konan hastalar dahil edildi. CLUE protokolü doğrultusunda çalışmaya dahil edilen hastalara akciğer ultrasonu (LUS) uygulandı ve yine protokol kapsamında hastalara 0 ile 36 arasında değişen LUS skorları verildi. Hastalar takibe alındı ve acil servisten çıkış, servise yatış, yoğun bakıma yatış veya çıkış klinik sonuçları kaydedildi. Taburculuk, yoğun bakıma yatış ve ölümleri öngören LUS puanları için sınır değerlerinin hesaplanmasında ROC analizi kullanıldı. Bulgular: Çalışmaya yaş ortalaması 63 ± 18 yıl olan 45 hasta dahil edildi. Hastaların 15' i (% 33) ayakta tedavi olmak üzere taburcu edildi, 12' si (% 27) servise, 18' i (% 40) yoğun bakım ünitesine yatırıldı. Toplam 15 (% 33) hastada ölüm meydana geldi. LUS puanının 3’ ün altın olması taburculuk için % 97 duyarlı ve % 80 spesifik, 10’ un üzerinde olması yoğun bakım ünitesine kabul için % 94 duyarlı ve % 78 spesifikti ve 11’ in üzerinde olması mortalite için % 93 duyarlı ve % 87 spesifik olarak bulundu. Regresyon analizine göre LUS skorunun 10’ un üzerinde olması yoğun bakım ihtiyacı için, 3’ ün altında olması taburculuk için ve 11’ in üzerinde olması ise mortalite için bağımsız bir risk faktörü olarak bulunmuştur. Sonuç: CLUE protokolü, COVID-19 triajında radyasyon içermeyen ve laboratuvar testleri gerektirmeyen yararlı bir yatak başı testi olabilir.

Anahtar Kelimeler

COVID-19, SARS-CoV-2, coronavirus, Triaj, yatakbaşı ultrason

Effectiveness of the CLUE protocol in COVID-19 triage

Öz

Purpose: The purpose of this study was to evaluate the effectiveness of the CLUE protocol in COVID-19 triage. Materials and Methods: Patients who presented to the emergency department due to dyspnea with oxygen saturation below 95 % and were diagnosed with COVID-19 by reverse transcription polymerase chain reaction (RT-PCR) tests were included in this prospective, observational study. Patients included in the study underwent lung ultrasound (LUS) in the light of the CLUE protocol, and were accordingly given LUS scores of between 0 and 36, also within the scope of the protocol. Patients were placed under observation, and clinical outcomes of discharge from the emergency department, admission to the ward, and admission to intensive care or discharge were recorded. ROC analysis was applied in the calculation of threshold values for LUS scores predicting discharge, admission to intensive care, and mortality. Results: Forty-five patients with a mean age of 63 ± 18 years were included in the study. Fifteen patients (33 %) were treated on an outpatient basis and discharged, while 12 (27 %) were admitted to the ward and 18 (40 %) to the intensive care unit. Mortality occurred in 15 (33 %) patients. An LUS score lower than 3 was 97 % sensitive and 80 % specific for discharge, a score greater than 10 was 94 % sensitive and 78 % specific for admission to the intensive care unit, and a score higher than 11 was 93 % sensitive and 87 % specific for mortality. Based on regression analysis, an LUS score higher than 10 emerged as an independent risk factor for intensive care requirement, a score lower than 3 for discharge, and a score over 11 for mortality. Conclusion: The CLUE protocol may be a useful bedside test in COVID-19 triage, and one that does not involve radiation or require laboratory tests.

Anahtar Kelimeler

Triage, bedside ultrasound, COVID-19

Kaynakça

1. Halacli B, Kaya A, Topeli A. Critically-ill COVID-19 patient. Turk J Med Sci. 2020 Apr 21;50(SI-1):585-591. doi: 10.3906/sag-2004-122. PMID: 32293831; PMCID: PMC7195980.
2. Veldhuis L, Ridderikhof ML, Schinkel M, van den Bergh J, Beudel M, Dormans T et al. Early warning scores to assess the probability of critical illness in patients with COVID-19. Emerg Med J. 2021 Dec;38(12):901-905. doi: 10.1136/emermed-2020-211054.
3. Martín-Rodríguez F, Martín-Conty JL, Sanz-García A, Rodríguez VC, Rabbione GO, Cebrían Ruíz I et al.Early Warning Scores in Patients with Suspected COVID-19 Infection in Emergency Departments. J Pers Med. 2021 Mar 2;11(3):170. doi: 10.3390/jpm11030170.
4. Zhang J, Meng G, Li W, Shi B, Dong H, Su Z et al.Relationship of chest CT score with clinical characteristics of 108 patients hospitalized with COVID-19 in Wuhan, China. Respir Res. 2020 Jul 14;21(1):180. doi: 10.1186/s12931-020-01440-x.
5. Yang R, Li X, Liu H, Zhen Y, Zhang X, Xiong Q, Luo Y, Gao C, Zeng W. Chest CT Severity Score: An Imaging Tool for Assessing Severe COVID-19. Radiol Cardiothorac Imaging. 2020 Mar 30;2(2):e200047. doi: 10.1148/ryct.2020200047. PMID: 33778560; PMCID: PMC723.
6. Shrestha GS, Weeratunga D, Baker K. Point-of-Care Lung Ultrasound in Critically ill Patients. Rev Recent Clin Trials. 2018 Jan 31;13(1):15-26. doi: 10.2174/1574887112666170911125750. PMID: 28901850.
7. Allinovi M, Parise A, Giacalone M, Amerio A, Delsante M, Odone A, Franci A, Gigliotti F, Amadasi S, Delmonte D, Parri N, Mangia A. Lung Ultrasound May Support Diagnosis and Monitoring of COVID-19 Pneumonia. Ultrasound Med Biol. 2020 Nov;46(11):2908-2917.
8. Farias LPG, Fonseca EKUN, Strabelli DG, Loureiro BMC, Neves YCS, Rodrigues TP, Chate RC, Nomura CH, Sawamura MVY, Cerri GG. Imaging findings in COVID-19 pneumonia. Clinics (Sao Paulo). 2020 Jun 22;75:e2027. doi: 10.6061/clinics/2020/e2027.
9. Manivel V, Lesnewski A, Shamim S, Carbonatto G, Govindan T. CLUE: COVID-19 lung ultrasound in emergency department. Emerg Med Australas. 2020 Aug;32(4):694-696. doi: 10.1111/1742-6723.13546. Epub 2020 Jun 16. PMID: 32386264; PMCID: PMC7273052.
10. Jiang F, Deng L, Zhang L, Cai Y, Cheung CW, Xia Z. Review of the Clinical Characteristics of Coronavirus Disease 2019 (COVID-19). J Gen Intern Med. 2020 May;35(5):1545-1549. doi: 10.1007/s11606-020-05762-w.

11. Lichter Y, Topilsky Y, Taieb P, Banai A, Hochstadt A, Merdler I et al.Lung ultrasound predicts clinical course and outcomes in COVID-19 patients. Intensive Care Med. 2020 Oct;46(10):1873-1883. doi: 10.1007/s00134-020-06212-1.
12. Ji L, Cao C, Gao Y, Zhang W, Xie Y, Duan Y et al.Prognostic value of bedside lung ultrasound score in patients with COVID-19. Crit Care. 2020 Dec 22;24(1):700. doi: 10.1186/s13054-020-03416-1.
13. Pokeerbux MR, Yelnik CM, Faure E, Drumez E, Bruandet A, Labreuche J et al.National early warning score to predict intensive care unit transfer and mortality in COVID-19 in a French cohort. Int J Clin Pract. 2021 Jun;75(6):e14121. doi: 10.1111/ijcp.14121.
14. Liang W, Liang H, Ou L, Chen B, Chen A, Li C et al. Development and Validation of a Clinical Risk Score to Predict the Occurrence of Critical Illness in Hospitalized Patients With COVID-19. JAMA Intern Med. 2020;180(8):1081-1089.
15. Armiñanzas C, Arnaiz de Las Revillas F, Gutiérrez Cuadra M, Arnaiz A, Fernández Sampedro M, González-Rico C et al.Usefulness of the COVID-GRAM and CURB-65 scores for predicting severity in patients with COVID-19. Int J Infect Dis. 2021 Jul;108:282-288.
16. Zhou S, Chen C, Hu Y, Lv W, Ai T, Xia L. Chest CT imaging features and severity scores as biomarkers for prognostic prediction in patients with COVID-19. Ann Transl Med. 2020 Nov;8(21):1449. doi: 10.21037/atm-20-3421

Ayrıntılar

Birincil Dil

İngilizce

Konular

Klinik Tıp Bilimleri

Bölüm

Araştırma Makalesi

Yazarlar

Hüseyin Acar
0000-0002-1905-7133
Türkiye

Adnan Yamanoğlu ^*
0000-0003-3464-0172
Türkiye

Cüneyt Arıkan
0000-0001-6823-5357
Türkiye

Serkan Bilgin
0000-0001-9345-8878
Türkiye

Pınar Yeşim Akyol
0000-0003-2477-1443
Türkiye

Ahmet Kayalı
0000-0003-2557-0600
Türkiye

Zeynep Karakaya
0000-0003-0562-8297
Türkiye

Yayımlanma Tarihi

30 Haziran 2022

Gönderilme Tarihi

11 Mart 2022

Kabul Tarihi

2 Mayıs 2022

Yayımlandığı Sayı

Yıl 2022 Cilt: 47 Sayı: 2

DOI

https://doi.org/10.17826/cumj.1086062

IZ

https://izlik.org/JA93RU26AS

APA

Acar, H., Yamanoğlu, A., Arıkan, C., Bilgin, S., Akyol, P. Y., Kayalı, A., & Karakaya, Z. (2022). Effectiveness of the CLUE protocol in COVID-19 triage. Cukurova Medical Journal, 47(2), 722-728. https://doi.org/10.17826/cumj.1086062

AMA

1.Acar H, Yamanoğlu A, Arıkan C, vd. Effectiveness of the CLUE protocol in COVID-19 triage. Cukurova Med J. 2022;47(2):722-728. doi:10.17826/cumj.1086062

Chicago

Acar, Hüseyin, Adnan Yamanoğlu, Cüneyt Arıkan, vd. 2022. “Effectiveness of the CLUE protocol in COVID-19 triage”. Cukurova Medical Journal 47 (2): 722-28. https://doi.org/10.17826/cumj.1086062.

EndNote

Acar H, Yamanoğlu A, Arıkan C, Bilgin S, Akyol PY, Kayalı A, Karakaya Z (01 Haziran 2022) Effectiveness of the CLUE protocol in COVID-19 triage. Cukurova Medical Journal 47 2 722–728.

IEEE

[1]H. Acar vd., “Effectiveness of the CLUE protocol in COVID-19 triage”, Cukurova Med J, c. 47, sy 2, ss. 722–728, Haz. 2022, doi: 10.17826/cumj.1086062.

ISNAD

Acar, Hüseyin - Yamanoğlu, Adnan - Arıkan, Cüneyt - Bilgin, Serkan - Akyol, Pınar Yeşim - Kayalı, Ahmet - Karakaya, Zeynep. “Effectiveness of the CLUE protocol in COVID-19 triage”. Cukurova Medical Journal 47/2 (01 Haziran 2022): 722-728. https://doi.org/10.17826/cumj.1086062.

JAMA

1.Acar H, Yamanoğlu A, Arıkan C, Bilgin S, Akyol PY, Kayalı A, Karakaya Z. Effectiveness of the CLUE protocol in COVID-19 triage. Cukurova Med J. 2022;47:722–728.

MLA

Acar, Hüseyin, vd. “Effectiveness of the CLUE protocol in COVID-19 triage”. Cukurova Medical Journal, c. 47, sy 2, Haziran 2022, ss. 722-8, doi:10.17826/cumj.1086062.

Vancouver

1.Hüseyin Acar, Adnan Yamanoğlu, Cüneyt Arıkan, Serkan Bilgin, Pınar Yeşim Akyol, Ahmet Kayalı, Zeynep Karakaya. Effectiveness of the CLUE protocol in COVID-19 triage. Cukurova Med J. 01 Haziran 2022;47(2):722-8. doi:10.17826/cumj.1086062