Article Figures & Data
Figures
- Figure 1
- Study flow chart. EMR: electronic medical record.
Tables
- Table 1
Patients characteristics, laboratory findings, vital signs, and chest x-ray findings at the time of the presentation.
Case No. Patients characteristics Laboratory findings Vital signs CXR findings ASA Age
(yr)Gender Ht
(cm)Wt
(kg)Hb
(g/dL)Plt
(103/µL)WBC
(103/µL)Lymphocyte
(%)CRP
(mg/dL)SpO2
(%)SBP
(mmHg)BT
(°C)1 I 20 F 168 53 13.6 190.0 3.8 32.9 1.59 100 100 36.6 NALL 2 III 75 F 160 55 12.8 315.0 20.0 8.0 0.06 98 180 35.7 NALL 3 II 50 F 169 62 13.7 161.0 3.5 9.8 0.13 100 150 37.6 Tiny calcified nodule in RUL 4 II 59 M 166 71 14.4 395.0 19.1 8.4 0.13 100 140 36.8 Rt. 6-9th rib fractures, pulmonary congestion 5 II 48 F 155 55 12.1 139.0 19.6 17.1 0.04 95 60 36.0 Lt. 1-7th rib fractures and hemopneumothorax 6 IV 70 F 160 59 12.1 231 9.9 11.8 0.05 90 200 36.7 Cardiomegaly, Pulmonary congestion and edema in both lung fields 7 II 32 F 163 63 11.7 258 5.8 8.0 - 98 110 37.2 NALL 8 II 22 F 168 66 13.5 392 11.1 12.6 0.16 100 100 37.6 NALL 9 IV 71 M 180 72 13.8 97 8.5 41.3 0.05 99 160 36.4 R/O both lung contusion 10 IV 82 F 150 45 10.1 326 13.0 6 1.24 50 110 36.0 R/O aspiration pneumonia 11 IV 16 F 160 50 8.5 215 8.9 77.1 0.37 Undetected - Subtle haziness in Rt. lung 12 II 26 M 180 80 15.2 350 11.8 21.4 0.02 99 100 36.6 NALL Reference ranges for laboratory tests: Hb: 13.5-17.5 g/dL, Plt: 140-420 103/µL, WBC: 3.8-11.0 103/µL, lymphocyte: 20-48.0%, and CRP: 0-0.5 mg/dL. ASA: American Society of Anesthesiologists physical classification, F: female, M: male, Hb: hemoglobin, Plt: platelets, WBC: white blood cells, CRP: c-reactive protein, SpO2: percutaneous arterial oxygen saturation, SBP: systolic blood pressure, BT: body temperature, CXR: chest x-ray, NALL: no active lung lesion, RUL: right upper lobe, R/O: rule out, (-): not measured, No.: number
- Table 2
- Clinical characteristics, comorbidities, specimen contamination, history of coronavirus disease-19, and clinical courses.
Case No. Department Chief complaint Comorbidities Head/facial trauma Specimen contamination by blood* COVID-19 history Pulmonary symptoms Isolation period** 1 ER Low abdominal pain None None - None None 4 hours Final diagnosis: pelvic inflammatory disease. Outcomes: outpatient follow-up without hospitalization. 2 ER Decreased mentality (semicoma) Hypertension Cerebral aneurysm None - None None 5.5 hours Final diagnosis: Lt. middle cerebral artery aneurysm rupture. Outcomes: after confirming the negative COVID-19 result of the real-time RT-PCR test, aneurysm coiling and aneurysm clipping with decompressive craniectomy were carried out; expired on POD11 (surgical delays***: 4 hours). 3 ER Chest pain, fever Total thyroidectomy state (due to thyroid cancer; TFT: n-s) None - Recovered COVID-19 patient (isolation lifted 6 days ago) Mild dyspnea 4 hours Final diagnosis: R/O chostochondritis. Outcomes: outpatient follow-up without hospitalization. 4 Trauma center TA (bicyclists),chest pain None Facial abrasion Not reported None Mild dyspnea 13 hours Final diagnosis: facial abrasion; Rt. 6-9th rib fx.; Rt. minimal pneumothorax. Outcomes: after admission, conservative treatment was carried out; discharged after 3 days 5 Trauma center Crushing injury None Panfacial fx. Bloody sample None Dyspnea 5 hours Final diagnosis: panfacial fracture; Lt. upper arm amputation; Lt. 1-7th rib fx.; Lt. scapular fracture. Outcomes: after confirming the negative COVID-19 result of the confirmatory rRT-PCR test, Lt. arm wound closure was carried out; open reduction and internal fixation were carried out for pan facial fracture, scapular fracture, and rib fracture; discharged on POD26 (surgical delays: 5.5 hours). 6 ER Dyspnea Uncontrolled hypertension, ESRD on HD, A-fib, and CHF None - Recovered COVID-19 patient (isolation lifted 14 days ago) Dyspnea one day Final diagnosis: CHF exacerbation (EF 50%->20%) and pulmonary edema. Outcomes: after emergency hemodialysis, cardiopulmonary function recovered; discharged after 4 days 7 ER Preterm labor Intrauterine pregnancy (30weeks) None - Recovered COVID-19 patient (isolation lifted 8 days ago) None one day Final diagnosis: preturm labor. Outcomes: emergency vaginal delivery was carried out in the ER; discharged after 2 days 8 ER Decreased mentality (drowsy) Mental retardation, bipolar disorder None - Recovered COVID-19 patient (isolation lifted 45 days ago) None one day Final diagnosis: catatonia. Outcomes: hospitalization and medication change, discharged after 29 days 9 Trauma center TA (pedestrian), decreased mentality (stupor) DM Skull fx. Not reported None None 3 hours Final diagnosis: traumatic SAH and SDH; multiple skull fx. Outcomes: after confirming positive rapid rRT-PCR test results, craniectomy was carried out in the negative pressure operating room with protective equipment (PAPRs), expired on POD3 (surgical delays: none). 10 ER Desaturation (SpO2 50%, room air) Tracheostomy state for management of COVID-19 ARDS (33 days ago) None - Recovered COVID-19 patient (isolation lifted 9 days ago) Desaturation 13 hours Final diagnosis: tracheostomy associated pneumonia. Outcomes: removes secretions by suctioning the tracheostomy tube. After desaturation improved, the patient was transferred to a community hospital. 11 Trauma center TA (motorcyclist), cardiac arrest. None Skull and panfacial fx. Bloody sample None None 20 hours Final diagnosis: traumatic SAH and SDH; skull fx.; panfacial fx.; Rt. pneumothorax; Rt. femur fx. Outcomes: after one cycle of CPR, the patient had a return of spontaneous circulation. Without confirming the rapid rRT-PCR test results, decompressive craniectomy was carried out in a negative pressure operating room after wearing PAPRs; expired on POD1 (surgical delays: none). 12 Trauma center Drunken state, glass laceration injuries on both arm and abdomen. None None Not reported None None 5 hours Final diagnosis: glass laceration injuries on both upper arm and abdomen. Outcomes: after confirming the negative COVID-19 result of the confirmatory rRT-PCR test, wound closure was carried out; discharged on POD7 (surgical delays: 5 hours). ↵* Whether sample contamination by blood was documented in the clinical laboratory footnote for patients with physical injury or trauma.
↵** Total isolation period for COVID-19 in our hospital.
↵*** Total delay in surgical intervention due to false-positive results in rapid rRT-PCR for COVID-19. ER: emergency room, POD: postoperative day, TFT: thyroid function test, n-s: nonspecific findings, R/O: rule out, TA: traffic accident, fx: fracture, ESRD: end-stage renal disease, HD: hemodialysis, CHF: chronic heart failure, EF; ejection fraction, DM; diabetes mellitus, rRT-PCR: real-time reverse-transcription polymerase chain reaction, SAH: subarachnoid hemorrhage, SDH: subdural hemorrhage, PAPR: powered air purifying respirator, ARDS: acute respiratory distress syndrome, SpO2: percutaneous arterial oxygen saturation
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