2022 · CLINICAL MICROBIOLOGY AND INFECTION

Imaging strategies used in emergency departments for the diagnostic workup of COVID-19 patients during the first wave of the pandemic: a cost-effectiveness analysis

Kepka, Sabrina, Zarca, Kevin, Viglino, Damien, Marjanovic, Nicolas, Taheri, Omide, Peyrony, Olivier, Desmettre, Thibaut, Wilme, Valerie, Marx, Tania, Muller, Joris, Harscoat, Sebastien, Le Borgne, Pierrick, Bayle, Eric, Lefebvre, Nicolas, Hansmann, Yves, Fafi-Kremer, Samira, Ohana, Mickael, Zaleski, Isabelle Durand, Bilbault, Pascal

Journal: CLINICAL MICROBIOLOGY AND INFECTION
Année: 2022
Volume: 28
Numéro: 12
Mois: DEC
DOI: 10.1016/j.cmi.2022.05.036

Abstract

Objectives: Emergency departments (EDs) were on the front line for the diagnostic workup of patients with COVID-19elike symptoms during the first wave. Chest imaging was the key to rapidly identifying COVID-19 before administering RT-PCR, which was time-consuming. The objective of our study was to compare the costs and organizational benefits of triage strategies in ED during the first wave of the COVID-19 pandemic. Methods: We conducted a retrospective study in five EDs in France, involving 3712 consecutive patients consulting with COVID-like symptoms between 9 March 2020 and 8 April 2020, to assess the cost effectiveness of imaging strategies (chest radiography, chest computed tomography (CT) scan in the presence of respiratory symptoms, systematic ultraelow-dose (ULD) chest CT, and no systematic imaging) on ED length of stay (LOS) in the ED and on hospital costs. The incremental cost-effectiveness ratio was calculated as the difference in costs divided by the difference in LOS. Results: Compared with chest radiography, workup with systematic ULD chest CT was the more costeffective strategy (average LOS of 6.89 hours; average cost of V3646), allowing for an almost 4-hour decrease in LOS in the ED at a cost increase of V98 per patient. Chest radiography (extendedly dominated) and RT-PCR with no systematic imaging were the least effective strategies, with an average LOS of 10.8 hours. The strategy of chest CT in the presence of respiratory symptoms was more effective than the systematic ULD chest CT strategy, with the former providing a gain of 37 minutes at an extra cost of V718. Discussion: Systematic ULD chest CT for patients with COVID-like symptoms in the ED is a cost-effective strategy and should be considered to improve the management of patients in the ED during the pandemic, given the need to triage patients. Sabrina Kepka, Clin Microbiol Infect 2022;28:1651.e1 e1651.e8

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