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Screening and testing for COVID ‐19 before surgery
Author(s) -
Kovoor Joshua G.,
Tivey David R.,
Williamson Penny,
Tan Lorwai,
Kopunic Helena S.,
Babidge Wendy J.,
Collinson Trevor G.,
Hewett Peter J.,
Hugh Thomas J.,
Padbury Robert T. A.,
Frydenberg Mark,
Douglas Richard G.,
Kok Jen,
Maddern Guy J.
Publication year - 2020
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.16260
Subject(s) - medicine , gold standard (test) , covid-19 , medline , intensive care medicine , diagnostic test , disease , infectious disease (medical specialty) , emergency medicine , political science , law
Background Preoperative screening for coronavirus disease 2019 (COVID‐19) aims to preserve surgical safety for both patients and surgical teams. This rapid review provides an evaluation of current evidence with input from clinical experts to produce guidance for screening for active COVID‐19 in a low prevalence setting. Methods An initial search of PubMed (until 6 May 2020) was combined with targeted searches of both PubMed and Google Scholar until 1 July 2020. Findings were streamlined for clinical relevance through the advice of an expert working group that included seven senior surgeons and a senior medical virologist. Results Patient history should be examined for potential exposure to severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Hyposmia and hypogeusia may present as early symptoms of COVID‐19, and can potentially discriminate from other influenza‐like illnesses. Reverse transcription‐polymerase chain reaction is the gold standard diagnostic test to confirm SARS‐CoV‐2 infection, and although sensitivity can be improved with repeated testing, the decision to retest should incorporate clinical history and the local supply of diagnostic resources. At present, routine serological testing has little utility for diagnosing acute infection. To appropriately conduct preoperative testing, the temporal dynamics of SARS‐CoV‐2 must be considered. Relative to other thoracic imaging modalities, computed tomography has the greatest utility for characterizing pulmonary involvement in COVID‐19 patients who have been diagnosed by reverse transcription‐polymerase chain reaction. Conclusion Through a rapid review of the literature and advice from a clinical expert working group, evidence‐based recommendations have been produced for the preoperative screening of surgical patients with suspected COVID‐19.