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

• Published in: PLoS medicine 2023-12, Vol.20 (12), p.e1004317-e1004317
• Main Authors: Leblanc, Judith, Dusserre-Telmon, Lisbeth, Chauvin, Anthony, Simon, Tabassome, Sabbatini, Chiara E, Hemming, Karla, Colizza, Vittoria, Bérard, Laurence, Convert, Jérome, Lazazga, Sonia, Jegou, Carole, Taibi, Nabila, Dautheville, Sandrine, Zaghia, Damien, Gerlier, Camille, Domergue, Muriel, Larrouturou, Florine, Bonnet, Florence, Fontanet, Arnaud, Salhi, Sarah, LeGoff, Jérome, Crémieux, Anne-Claude
• Format: Article
• Language: English
• Subjects: Asymptomatic; Biology and life sciences; Comparative analysis; Consent; Coronaviruses; COVID-19; Data collection; Data warehouses; Disease transmission; Earth Sciences; Emergency medical care; Emergency service; Epidemics; Epidemiology; Health aspects; Hospital patients; Hospitals; Infections; Low income groups; Medical screening; Medicine and health sciences; Methods; Nurses; Pandemics; Patients; Questionnaires; RNA polymerase; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Social Sciences
• ISSN: 1549-1676; 1549-1277; 1549-1676
• DOI: 10.1371/journal.pmed.1004317

Asymptomatic and paucisymptomatic infections account for a substantial portion of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) transmissions. The value of intensified screening strategies, especially in emergency departments (EDs), in reaching asymptomatic and paucisymptomatic patients and helping to improve detection and reduce transmission has not been documented. The objective of this study was to evaluate in EDs whether an intensified SARS-CoV-2 screening strategy combining nurse-driven screening for asymptomatic/paucisymptomatic patients with routine practice (intervention) could contribute to higher detection of SARS-CoV-2 infections compared to routine practice alone, including screening for symptomatic or hospitalized patients (control). We conducted a cluster-randomized, two-period, crossover trial from February 2021 to May 2021 in 18 EDs in the Paris metropolitan area, France. All adults visiting the EDs were eligible. At the start of the first period, 18 EDs were randomized to the intervention or control strategy by balanced block randomization with stratification, with the alternative condition being applied in the second period. During the control period, routine screening for SARS-CoV-2 included screening for symptomatic or hospitalized patients. During the intervention period, in addition to routine screening practice, a questionnaire about risk exposure and symptoms and a SARS-CoV-2 screening test were offered by nurses to all remaining asymptomatic/paucisymptomatic patients. The primary outcome was the proportion of newly diagnosed SARS-CoV-2-positive patients among all adults visiting the 18 EDs. Primary analysis was by intention-to-treat. The primary outcome was analyzed using a generalized linear mixed model (Poisson distribution) with the center and center by period as random effects and the strategy (intervention versus control) and period (modeled as a weekly categorical variable) as fixed effects with additional adjustment for community incidence. During the intervention and control periods, 69,248 patients and 69,104 patients, respectively, were included for a total of 138,352 patients. Patients had a median age of 45.0 years [31.0, 63.0], and women represented 45.7% of the patients. During the intervention period, 6,332 asymptomatic/paucisymptomatic patients completed the questionnaire; 4,283 were screened for SARS-CoV-2 by nurses, leading to 224 new SARS-CoV-2 diagnoses. A total of 1,859 patients versus 2,084 pati