EWS and Triage in COVID - 19

Handrian Purawijaya, MD
Emergency Physician
Covid Emergency Hospital, Wisma Atlit Kemayoran
A multi – paramater screening tool to identify highly suspected patient

EWS IN COVID - 19
 • Corona Virus Disease 2019 (COVID-19) is
spreading worldwide.
• Effective screening for patients is important to
limit the epidemic.
• In Early pandemic, develop a diagnostic model
that allows for the quick screening of highly
suspected patients using easy-to-get
variables is key

Song CY, Xu J, He JQ, Lu YQ. COVID-19 early warning score: a multi-parameter screening tool to identify highly suspected patients. MedRxiv. 2020 Jan 1 .
 • Published in early 2020
• This scoring tool allows
clinicians to more
quickly and relatively
accurately detect
COVID-19 patients,
especially when the
nucleicacid detection
capacity is relatively
lacking.

Song CY, Xu J, He JQ, Lu YQ. COVID-19 early warning score: a multi-parameter screening tool to identify highly suspected patients. MedRxiv. 2020 Jan 1.
MODIFIED NEWS ESPECIALLY FOR
COVID - 19
 • In early 2020, every country prepare for
admission of additional critically ill patients as
a matter of emergency
• In the event of Pandemic, ED must choose
which patient most benefit from ICU Care
• Focus is on the management of the most
severe patients in the event unable to predict
how many critically ill patients will be received

Liao X, Wang B, Kang Y. Novel coronavirus infection during the 2019–2020 epidemic: preparing intensive care units—the experience in Sichuan Province, China. Intensive care medicine. 2020 Feb;46(2):357-60.
Liao X, Wang B, Kang Y. Novel coronavirus infection during the 2019–2020 epidemic: preparing intensive care units—the experience in Sichuan Province, China. Intensive care medicine. 2020 Feb;46(2):357-60.
Liao X, Wang B, Kang Y. Novel coronavirus infection during the 2019–2020 epidemic: preparing intensive care units—the experience in Sichuan Province, China. Intensive care medicine. 2020 Feb;46(2):357-60.
 • The identification of variables related to worse
outcomes is key for triaging and adapting the
intensity of care that each patient requires,
allowing effective strategic planning and better
administration of human and material resources.
• The need for a sensitive and predictive model is
mandatory to avoid a delayed recognition of
severely ill patients or those at risk of presenting
further complications

Huespe, I., Carboni Bisso, I., Di Stefano, S., Terrasa, S., Gemelli, N. A., & Las Heras, M. (2020). COVID-19 Severity Index: A predictive score for hospitalized patients.  Medicina intensiva, 46(2), 98–101. Advance online
publication. https://doi.org/10.1016/j.medin.2020.12.001
Huespe, I., Carboni Bisso, I., Di Stefano, S., Terrasa, S., Gemelli, N. A., & Las Heras, M. (2020). COVID-19 Severity Index: A predictive score for hospitalized patients.  Medicina intensiva, 46(2), 98–101. Advance online
publication. https://doi.org/10.1016/j.medin.2020.12.001
Huespe, I., Carboni Bisso, I., Di Stefano, S., Terrasa, S., Gemelli, N. A., & Las Heras, M. (2020). COVID-19 Severity Index: A predictive score for hospitalized patients.  Medicina intensiva, 46(2), 98–101. Advance online
publication. https://doi.org/10.1016/j.medin.2020.12.001
COVID – 19 TRIAGE
 TRIAGE
• “The sorting out and classification of patients or
casualties to determine priority of need and proper
place of treatment.”
• Triage is particularly important to separate patients
likely to be infected with the pathogen of concern.
• Triage developed in the context of the COVID-19
pandemic and does not replace any routine clinical
triage SOPs in place in healthcare facilities to
categorize patients into different urgency categories.
(ATS, ESI, etc..)

World Health Organization. Clinical management of COVID-19external icon. Accessed on May 18, 2021
TRIAGE START EVEN BEFORE
PATIENT ARRIVE AT THE HOSPITAL…
 • Establish a hotline (119)
• Provide information to the
general public through
local mass media such as
radio, television,
newspapers, and social
media platforms
• Consider telemedicine to
provide clinical support
without direct contact
with the patient
World Health Organization. Telemedicine: opportunities and developments in Member States: report on the second global survey on eHealth. Global Observatory for eHealth
Series, 2, World Health Organization. 2009pdf iconexternal icon
Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected [interim guidance]. Geneva: World Health Organization; 2020.
TRIAGE SET UP IN HOSPITAL
 • Limit point of entry to the
health facility.
• Have clear sign at the
enterance of the facility
directing patients with
COVID-19 symptoms
• Assign dedicated clinical staff
(e.g. physicians or nurses) for
physical evaluation of
patients presenting with
COVID-19 symptoms at
triage

World Health Organization. Clinical management of COVID-19external icon. Accessed on May 18, 2021
 ED TRIAGE

Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected [interim guidance]. Geneva: World Health Organization; 2020.
 What healthcare workers (HCWs) can do to protect
themselves and their patients during triage

• HCW should get vaccinated

• All HCWs should adhere
to Standard precautions
• Follow appropriate PPE
donning and doffing
procedure
• Perform frequent hand
hygiene with an alcohol-based
hand rub
• HCWs who develop symptoms
suggestive of COVID-19 (e.g.,
fever, cough, shortness of
breath, loss of smell or taste,
sore throat) should stay home
World Health Organization. Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected or confirmedexternal icon
. Accessed on Aug 25, 2021
TRIAGE AND REFFERAL
Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected. Geneva: World Health Organization; 2020.
2. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI et al. Defining community acquired pneumonia severity on presentation to hospital: an
international derivation and validation study. Thorax. 2003;58(5):377–82.
CLINICAL TRIAGE
• Routine clinical triage in healthcare facilities
• Categorize patients into different
urgency/emergency.
• Depend on healthcare fasilities ( ATS/ESI/ 3 –
level triage )
 ESI TRIAGE SCALE
Severe
Pnemonia
and SpO2 <

93 %

Critical
e.G :
Respiratory
Failure, shock

Mild / Asymptomatic

Moderate
SOB and pnemonia
SpO2 > 93%

Wuerz RC, Travers D, Gilboy N, Eitel DR, Rosenau A, Yazhari R. Implementation and refinement of the emergency severity index. Academic Emergency Medicine. 2001 Feb;8(2):170-6.