Mediterranean Journal of Emergency Medicine & Acute Care

Introduction: During the COVID-19 pandemic, screening asymptomatic admitted patients for COVID-19 became routine in order to minimize the potential risk of these individuals as silent but infectious hosts in the propagation of this pandemic. However, testing is costly and the value of this indiscriminate testing was not studied. Hence, our study aimed to determine the rates of positive COVID-19 PCR results in patients presenting to the emergency department (ED) with no suspicion for a COVID-19 infection at different times during the pandemic.

Methods: This was a retrospective cohort study of asymptomatic patients presenting to the ED with no COVID infection risk factors, in an urban, tertiary care hospital in Lebanon, from March 2020 to January 2021, representing periods with different national incidence rates of COVID-19. We included patients of all ages, from the last 15 days of each month, who were tested for COVID-19 by PCR in the ED and who fulfilled the following “screening group” criteria: no travel within the last 14 days; no known COVID-19 exposure within the last 14 days; and no symptoms or physical exam findings that could be associated with a COVID-19 infection. We collected data on age, and PCR result.

Results: We identified 3,853 patients who underwent COVID-19 PCR test during the above time intervals in our ED. The rate of test positivity in the community during this study period ranged from 1.1% to 21.8%. Out of the 743 (19.3%) patients that fit our inclusion criteria, none had a positive COVID-19 test.

Conclusion: Even during high countrywide incidence rates of COVID-19, all patients in the screening group had a negative PCR. Algorithms identifying this group can be used to minimize a costly test, to avoid delaying inpatient care or surgeries and to reduce patient’s length of stay in already overwhelmed EDs.

Introduction: Unscheduled return visits are an important quality indicator in the emergency department. We aim to compare clinical characteristics and ED resource usage of pediatric high risk unscheduled return visits (HRURVs) between the index and return visit and explore root cause of HRURVs.

Methods: A retrospective chart-review study conducted between November 1, 2014 and October 31, 2015. All patients who returned to the ED within 72 hours of discharge and were admitted or died on re-presentation were considered.

Results: The incidence rate of HRURV in our study was 0.96% (95%, CI:0.81-1.13%). We found that significantly more patients were febrile on index visit than on the return visit. In contrast, HRURV patients had significantly more imaging, labs, IV fluids, ED consults and procedures on return visit. Also, the return visit length of stay (LOS) was significantly higher than on index visit (2.76±1.82 Vs. 5.88±0.44). Upon revisit, 2.2% of patients required ICU admission and 7.9% required surgery. The most common discharge diagnosis were digestive system disorders (29.5%) and infectious/parasitic diseases (27.3%). Only infectious/parasitic disease showed a high number of changes in diagnosis from first to second visit. The majority (73.4%) of HRURVs were classified as being “illness-related”. Digestive disorders accounted for the largest portion of “physician related” reasons for revisit (41%).

Conclusion: HRURV patients require more resources on return visits and have longer ED stays than the index visit. While the majority of re-visits do not lead to a change in diagnosis and are primarily related to progression of disease, specific attention should be paid to digestive disorders where physician related causes were high and which account for 18% of surgeries on return visit.

Acute pulmonary embolism is stratified into three groups: low-risk, moderate-risk, and high-risk. Highrisk PE, also known as massive pulmonary embolism (MPE), is defined as an acute PE with sustained hypotension, pulselessness, and persistent bradycardia. Herein, we present a case of a 44-year-old female presenting to the emergency department with shortness of breath, chest discomfort, and central cyanosis. She was found to have MPE and arrested twice during which she received alteplase and Advanced Cardiac Life Support. In the ICU, she arrested for the third time, was resuscitated, and a decision to initiate extracorporeal membrane oxygenation deemed reasonable. The patient deteriorated and was rushed to the operating room after detecting major intra-abdominal bleeding on FAST exam. Hepatic injury was suspected and liver packing was initiated. Patient was safely discharged home neurologically intact after a prolonged hospital stay.