Universal Testing for COVID-19 in Essential Orthopaedic Surgery Reveals a High Percentage of Asymptomatic Infections
Universal Testing for COVID-19 in Essential Orthopaedic Surgery Reveals a High Percentage of Asymptomatic Infections
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DOI：
10.2106/jbjs.20.01053
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发表时间：
2020-08-19
影响因子：
5.3
通讯作者：
Ricci, William M.
中科院分区：
文献类型：
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作者：
Gruskay, Jordan A.;Dvorzhinskiy, Aleksey;Ricci, William M.
背景：COVID-19 的长潜伏期和无症状传播给医疗机构带来了相当大的挑战。识别感染者对于防止疾病传播给工作人员和其他患者以及识别可能面临疾病相关并发症风险的人至关重要。这与世界各地恢复择期骨科手术尤其相关。我们报告了冠状病毒大流行期间接受骨科手术的患者的 COVID-19 通用检测方案的结果，并描述了 COVID-19 呈阳性的无症状患者的术后病程。方法：对纽约市一家骨科专科医院2020年3月25日至2020年4月24日期间的成人手术病例进行回顾性分析。最初，由相关体征和症状（例如发烧、咳嗽、呼吸急促）或暴露情况组成的筛查问卷表明，需要对所有入院患者进行鼻咽拭子实时定量聚合酶链反应（RT-PCR）检测。 2020 年 4 月 5 日发生了一项机构政策变更，要求对所有骨科入院人员进行鼻咽拭子 RT-PCR 检测。对所有患者的 COVID-19 筛查和检测数据以及相关影像学、实验室值和术后并发症进行了审查。结果：从 2020 年 4 月 5 日到 2020 年 4 月 24 日，99 名患者在计划进行骨科手术之前接受了常规鼻咽拭子检测以检测 COVID-19。在 12.1% 的 COVID-19 检测呈阳性的患者中，58.3% 无症状。 3 名无症状患者出现术后缺氧，其中 2 名需要插管。使用疾病体征和症状来预测阴性检测结果的阴性预测值为 91.4%（95% 置信区间 [CI]，81.0% 至 97.1%）。将胸部 X 线检查结果阳性作为筛查标准并不能提高筛查的阴性预测值（92.5% [95% CI，81.8% 至 97.9%]）。结论：一项在 3 周内对纽约市 1 家医院所有骨科手术入院患者进行普遍检测的方案显示，COVID-19 感染率很高。重要的是，这些患者大多数没有症状。使用胸部X光检查并没有显着提高筛查的阴性预测值。这些结果具有重要意义，因为医院预计将恢复选择性外科手术。
Background: The long incubation period and asymptomatic spread of COVID-19 present considerable challenges for health-care institutions. The identification of infected individuals is vital to prevent the spread of illness to staff and other patients as well as to identify those who may be at risk for disease-related complications. This is particularly relevant with the resumption of elective orthopaedic surgery around the world. We report the results of a universal testing protocol for COVID-19 in patients undergoing orthopaedic surgery during the coronavirus pandemic and to describe the postoperative course of asymptomatic patients who were positive for COVID-19. Methods: A retrospective review of adult operative cases between March 25, 2020, and April 24, 2020, at an orthopaedic specialty hospital in New York City was performed. Initially, a screening questionnaire consisting of relevant signs and symptoms (e.g., fever, cough, shortness of breath) or exposure dictated the need for nasopharyngeal swab real-time quantitative polymerase chain reaction (RT-PCR) testing for all admitted patients. An institutional policy change occurred on April 5, 2020, that indicated nasopharyngeal swab RT-PCR testing for all orthopaedic admissions. Screening and testing data for COVID-19 as well as relevant imaging, laboratory values, and postoperative complications were reviewed for all patients. Results: From April 5, 2020, to April 24, 2020, 99 patients underwent routine nasopharyngeal swab testing for COVID-19 prior to their planned orthopaedic surgical procedure. Of the 12.1% of patients who tested positive for COVID-19, 58.3% were asymptomatic. Three asymptomatic patients developed postoperative hypoxia, with 2 requiring intubation. The negative predictive value of using the signs and symptoms of disease to predict a negative test result was 91.4% (95% confidence interval [CI], 81.0% to 97.1%). Including a positive chest radiographic finding as a screening criterion did not improve the negative predictive value of screening (92.5% [95% CI, 81.8% to 97.9%]). Conclusions: A protocol for universal testing of all orthopaedic surgery admissions at 1 hospital in New York City during a 3-week period revealed a high rate of COVID-19 infections. Importantly, the majority of these patients were asymptomatic. Using chest radiography did not significantly improve the negative predictive value of screening. These results have important implications as hospitals anticipate the resumption of elective surgical procedures.