Accuracy of Emergency Department Coronavirus Disease-2019 Symptom Screening: A Retrospective Chart Review

J Emerg Nurs. 2025 May;51(3):356-365. doi: 10.1016/j.jen.2024.11.005.

ABSTRACT

INTRODUCTION: Severe acute respiratory syndrome coronavirus 2, originating in late 2019 in Wuhan, China, caused a global pandemic. During the pandemic, patients with respiratory symptoms were screened by frontline health care workers, and those with coronavirus disease 2019 symptoms were isolated. Screening was vital to prevent disease transmission. This study aimed to identify symptoms in patients who screened negative for coronavirus disease 2019 during initial triage but later tested positive.

METHODS: A retrospective chart review was conducted on adult patients in a community hospital emergency department. Patients who screened negative but tested positive for coronavirus disease 2019 via polymerase chain reaction within 12 hours of their visit were included. The review covered 128 records. Providers’ notes were examined for symptoms. Cases where respiratory symptoms indicated a missed positive screen were identified.

RESULTS: The most common symptoms were gastrointestinal, followed by neurological and psychiatric. Of 128 records, 32 were missed triage screens where provider notes suggested patients should have screened positive. High-risk groups included older adults, those with cognitive deficits, patients under the influence of substances, and those with psychiatric complaints. These groups may benefit from automatic coronavirus disease 2019 testing.

DISCUSSION: Accurate triage screening remains critical. Screening criteria should evolve with the virus. High-risk populations, such as older adults, patients with psychiatric histories, and those with substance use disorders, should be assessed for automatic coronavirus disease 2019 testing. Nurses play a key role in ensuring accurate screening and recognizing potential coronavirus disease 2019 cases.

PMID:40340050 | DOI:10.1016/j.jen.2024.11.005