The effectiveness of intensified screening for SARS-CoV-2 by nursing teams in emergency departments

Before the vaccine became available, the detection and isolation of people carrying the SARS-CoV-2 virus were essential measures for controlling the epidemic, but this was made difficult by the large proportion of asymptomatic or paucisymptomatic (with few symptoms) individuals. One possible strategy for reducing the impact of the epidemic was to offer screening during consultations, particularly in emergency departments.  However, no study had evaluated this approach. Yet evaluating screening is essential to identify appropriate strategies and draw possible lessons for other emerging respiratory viruses.

The aim of the DEPIST-COVID trial was to study the benefit of an intensified SARS-CoV-2 screening strategy combining nurse-driven screening for asymptomatic/paucisymptomatic adult patients with usual practice (screening of symptomatic or hospitalised patients), compared with routine screening practice alone. The study, which awarded a National Priority Label (REACTing, CAP-NET), was conducted from February to May 2021 and included 138,352 patients in 18 emergency departments in the Île-de-France region.

During the intervention period, 4,283 asymptomatic/paucisymptomatic patients were screened, leading to 224 new diagnoses. Overall, taking into account the usual practice of screening symptomatic or hospitalised patients, intensified screening led to 26.7 new diagnoses/1,000 patients compared with 26.2/1,000 with the usual practice (relative risk: 1.02; IC95%: 0.94-1.11), suggesting that intensified screening was unlikely to provide a substantial benefit in detecting SARS-CoV-2 infections.

The objective of the study was also to improve access to screening for populations who may be more susceptible to infections and less likely to be screened. The proportion of new diagnoses among asymptomatic/paucisymptomatic patients in emergency departments was higher than that observed regionally through general population screening (5.2% and 4.6%, risk difference: 0.6%; IC95%: 0.01% -1.3%). The emergency department population appeared to be more affected by SARS-CoV-2. Intensified screening in these departments could provide access to a large population, including groups at greater risk.

The limitations of this study are that it was conducted in a rapidly evolving epidemiological context marked by a pandemic wave associated with lockdowns, and that out-of-hospital testing was made very accessible during the study period, which may have reduced the impact of the intervention. This encourages further exploration of screening strategies for SARS-CoV-2 and asymptomatically transmitted respiratory viruses to better define the observatory role of emergency departments in emerging epidemics.

 

This study was promoted by the AP-HP, funded by the ANRS Emerging Infectious Diseases and the Île-de-France region, and conducted with the help of Pr Tabassome Simon’s East Paris clinical research platform and the IMPEC FHU.

Référence

Judith Leblanc, Lisbeth Dusserre-Telmon, Anthony Chauvin, Tabassome Simon, Chiara E. Sabbatini, Karla Hemming, Vittoria Colizza, Laurence Berard, Jerome Convert, Sonia Lazazga, Carole Jegou, Nabila Taibi, Sandrine Dautheville, Damien Zaghia, Camille Gerlier, Muriel Domergue, Florine Larrouturou, Florence Bonnet, Arnaud Fontanet, Sarah Salhi, Jerome LeGoff, Anne-Claude Cremieux ; DEPIST-COVID group; FHU IMPEC (Improving Emergency Care) group. Intensified screening for SARS-CoV-2 in 18 emergency departments in the Paris metropolitan area, France (DEPIST-COVID): A cluster-randomized, two-period, crossover trial. PLoS Med. 2023 Dec 7;20(12):e1004317.

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