Introduction:
During the initial Coronavirus Disease 2019 (COVID-19) pandemic wave, sparse personal protection equipment made telephone triage of suscpeted COVID-19 patients for ambulance transport necessary. To spare resources, stable patients were often treated and released on-scene, but reports from Italy suggested that some later detoriated. We implemented a prehospital sit-stand test to identify patients in risk for detoriation.
Methods
The test was implemented as part of a new guideline in stable suspected COVID-19 patients younger than 70 years with no risk factors for serious disease triaged by general practitioners to ambulance response in the Central Denmark Region. Data were collected from April 6th to July 6th 2020. This was a two-part study evaluating guideline adherence and results of the sit-stand test. The primary outcome of each separate part was 1) the proportion of patients sit-stand tested before treat-and-released and 2) the proportion of patients treated with oxygen within 7 days among patients decompensating and not decompensation during the test.
Results
Data on 156 patients triaged to ambulance response by general practioners were analysed. In total 86/156 (55%) were tested with the sit-stand test, among these 30/86 (47%) were either older than 70 or had risk factors for serious disease. Of those treated and released, 50/52 (96%) were tested. In total, 17/86 (20%) decompensated during the test and of these, 9/17 (53%) were treated with oxygen compared to 2/69 (3%) in patients who did not decompensate (p < 0.001). This difference was only significant in the elderly group of patients with risk factors for serious disease. 10/156 (6%) of patients had a positive COVID-19-test.
Conclusion
The sit-stand test was implemented in 96% of patients treated and released on-scene, but was also used in elderly patients with risk factors for serious disease. Decompensation was observed in 20% of patients and was associated with oxygen treatment within 7 days – but only in the elderly group of patients with risk factors for serious disease. These findings are hypotheses-generating and suggest that physical exercise testing may be usefull for decision making in emergency settings.