Original Article

Predictive parameters of potential COVID-19 without epidemiological clues and management strategy in resources limited setting

Authors: Kok Wei Poh, Pei Wen Tan, Ji Yin Wong, Cheng Huong Ngan, Yin Jie Ng, Raymund Dass, Tiang Koi Ng.

ABSTRACT
Background
Managing potential COVID-19 patients is challenging when resources were limited. The objective of this study was to evaluate the predictive parameters and management strategy for potential COVID-19 cases who are without contact or travelling history.

Methods
Retrospective study of potential COVID-19 patients without direct contact or travelling history, admitted to Hospital Tuanku Ja’afar Seremban. Patients were riskstratified to either low or medium risk and admitted to designated wards, respectively. They were categorised to severe acute respiratory infection (SARI); influenzalike illness (ILI); dengue fever or viral fever like (DVF); or none. Clinical, laboratory and radiological variables were evaluated for predictive value. Positive cases were isolated to negative pressure isolation rooms and the neighbouring patients underwent surveillance.

Results
812 patients were studied, with 478 fulfilled SARI, ILI, and DVF. 18 (2.2%) of them were COVID-19 positive, and all patients in “none” group were negative. Hypoxia without dyspnoea and medium risk criteria were significant in predicting COVID-19 with p<0.01 (OR 7.18; 95% CI 2.70, 19.13) and p<0.01 (OR 35.77; 95% CI 11.25, 113.71) respectively. Absolute lymphocyte count showed no predictive value (P=0.88 95% CI -0.78, 0.90). Absolute neutrophil count ≥10 x10^9/L cells (OR 0.11; 95% CI 0.01, 0.87) helped to exclude COVID-19. Chest radiograph of 16 (88.9%) COVID-19 patients showed heterogeneous Ill-defined opacities. No nosocomial transmission occurred during this study period.

Conclusion / Implication
Initial attention to predictive parameter, riskstratification, clinical grouping strategy, and proper ward management helps in containment of COVID-19 and resources management without risk of nosocomial transmission.

Citation: IEJSME 2020 14 (3): 16-29