Original/Research Article

SARS-CoV-2 Antigen Rapid Test in The Emergency Department; a Diagnostic Accuracy Study

Saeed Safari, Faezeh Golpour, Mohammad Mehdi Forouzanfar, Behrooz Hahsemi, Shahram Ebrahimi, Nastaran Sadat Mahdavi

Iranian Journal of Emergency Medicine, Vol. 10 No. 1 (2023), , Page e1

Title: Evaluation of diagnostic value of SARS-CoV-2 rapid diagnostic test in patients with Covid-19

Introduction: The standard RT-PCR test is a time-consuming diagnostic test with difficult accessibility and high cost, so in order to early diagnose and prevent the spread of Covid-19 disease, access to a quick, inexpensive diagnostic test with easy access is essential. This study aimed to evaluate diagnostic value of SARS-CoV-2 rapid diagnostic test in patients with Covid-19.

Materials & Methods: The present study is a cross-sectional study in type of diagnostic value that was performed on 188 patients with symptoms of Covid-19 referred to the emergency department of Imam Hossein and Shohadaye Tajrish hospitals in Tehran. In this study, SARS-CoV-2 rapid diagnostic test was performed immediately after sampling and according to the manufacturer's instructions (reading in 10 minutes). Then chest CT scan was performed less immediately after collecting samples to compare with the results of rapid antigen detection test. Data were collected and analyzed using Spss software V.26 and descriptive-mean and Chi-square statistical tests.

Results: Results showed that out of 83 patients who were diagnosed with Covid-19 positively based on rapid diagnostic test, all of them (100%) were also positive based on chest CT scan results, and out of 100 patients diagnosed Covid-19 negative based on rapid diagnostic test, 42 patients (42%) were true negative and 58 were positive base of chest CT scan results. The sensitivity of the rapid diagnostic test compared to chest CT scan was 100%, its specificity was 42%, its positive predictive value was 58.86% and its negative predictive value was 100%.

Conclusion: Due to the high accuracy and rapid diagnostic of rapid diagnostic test (SARS-CoV-2), this test is a valid and reliable tool for rapid diagnosis of Covid-19 disease in emergency cases.

Associated Factors of In-hospital Outcomes in Emergency Department's Cardiopulmonary Resuscitation; a Cross-Sectional Study

Saeed Safari, Mohammad Mehdi Forouzanfar, Masoume Bakhshi, Behrooz Hashemi, Shayan Roshdi Dizaji, Nastaran Sadat Mahdavi

Iranian Journal of Emergency Medicine, Vol. 10 No. 1 (2023), , Page e2

Introduction: Even though the basic principles of cardiopulmonary resuscitation (CPR) are simple, the patients' outcome remains inconsistent. This study aimed to investigate the CPR outcomes and associated factors in the emergency department.

Method: This cross-sectional study was conducted on patients who underwent in-hospital CPR following a cardiac arrest in the emergency department for one year. The patient's baseline characteristics and CPR outcomes were recorded from patients' profiles, and the association of patient-related and CPR-related variables with the outcomes was assessed.

Results: 220 patients with a mean age of 71.5 ± 16.9 (range: 20-100) years were included (60.5% male). 193 cases of cardiac arrests had occurred in the hospital. Presenting cardiac rhythm in 198 cases (90.0 %) was asystole (not requiring defibrillation). The mean duration of conducted CPR was 43.2 ± 15.6 (5-120) minutes. Only 7 patients (3.2%) achieved the return of spontaneous circulation (ROSC) and were discharged from the hospital, with one suffering from neurological impairment due to CPR. There was a significant association between age (p = 0.047), consciousness status at admission (p = 0.003), presenting cardiac rhythm at CPR initiation (p = 0.0001), and establishment of ROSC under 45 minutes (p = 0.043) with patients' outcomes. Presenting cardiac rhythm at CPR initiation (p = 0.001), ROSC under 45 minutes (p = 0.012), and consciousness status at admission (p = 0.027) were independent predictive factors of survival. The area under the ROC curve for presenting cardiac rhythm and ROSC under 45 minutes was 0.817 (95% CI: 0.617-1.000) and 0.805 (95% CI: 0.606-1.000), respectively.

Conclusion: Based on the present study's findings, the survival rate of patients after CPR in ED was 3.2%. Presenting cardiac rhythm, ROSC under 45 minutes, and consciousness status at admission was among the independent predictors of mortality.

Case Report

Renal Infarction following Asymptomatic Aortoiliac Thrombosis as a Cause of Severe Flank Pain; a Case Report

AbdolGhader Pakniyat, Rojin Ramezani, Hojjat Rastegari, Alireza Bahmani

Iranian Journal of Emergency Medicine, Vol. 10 No. 1 (2023), , Page e3

Renal infarction is rare and may be considered acute renal colic in presentation. In this report, we describe a case of renal infarction caused by thrombosis that extended from the aortoiliac to the infrapopliteal segment, along with thrombosis that occurred in the right popliteal artery and left atrium. A 48-year-old man was referred to the emergency department (ED) suffering left flank pain. The pain was significant with radiation to the left lower quadrant, and the pain did not significantly decrease despite intravenous ketorolac and morphine sulfate administration. We decided to perform a color Doppler ultrasound test of intraabdominal vessels that revealed low flow in the left iliac artery. By computed tomography angiography (CTA), it was confirmed that the left renal, iliac, and popliteal arteries were thrombosed. The patient underwent anticoagulation, thrombectomy, and Mitral valve replacement surgery during the hospitalization. After 14 days, his heart rhythm returned to normal sinus and he was discharged from the hospital with proper outpatient follow-up. Patients with severe flank pain and who do not respond to routine treatments, especially patients with significant risk factors, should be evaluated more carefully for red flag diagnosis.