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Screening Testing for SARS-CoV-2 upon Admission to Rehabilitation Hospitals in a High COVID-19 Prevalence Community
Steven C Kirshblum1,2,3, Gabrielle DeLauter3, Maeve C Lopreiato1,2
1Kessler Institute for Rehabilitation, West Orange, NJ, USA.
Background:
While planning for the care of coronavirus disease 2019 (COVID-19) patients during the pandemic crisis has dominated the focus of leaders of inpatient rehabilitation facilities (IRFs), patients with injuries/illnesses unrelated to COVID-19 continue to need inpatient rehabilitation admission. To maintain a safe environment for all patients and staff, we established an admission screening plan of testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to determine the presence of asymptomatic patients who were infected with the virus upon admission.
Objective:
To determine the prevalence of patients who test positive for SARS-CoV-2 but were presumed to be COVID-19 negative at the time of admission to IRF in New Jersey.
Design:
Retrospective analysis of SARS-CoV-2 testing results.
Setting:
Four freestanding IRFs in New Jersey operated as one system.
Patients:
All (N = 103) patients sequentially admitted from 4 to 27 April 2020 with no symptoms or evidence of COVID-19 disease at the time of transfer from the acute hospital.
Interventions:
Specimens were collected for SARS-CoV-2 analysis at the time of admission to the IRF and patients were monitored for subsequent symptom development over the next 14 days.
Main Outcome Measures:
Results of SARS-CoV-2 testing upon admission and evidence of development of clinical signs or symptoms of COVID-19.
Results:
Seven asymptomatic persons (6.8% of admissions) without clinical signs/symptoms of COVID-19 tested positive on admission. Of these, five developed symptoms of COVID-19, with a mean onset of 3.2 (range of 2-5) days. Five additional patients became symptomatic and tested positive within the next 3 to 10 days (mean of 5.2 days). Overall, 11.6% of admissions (12/103) had a positive test within 14 days of admission.
Conclusions:
Admission testing to postacute centers for SARS-CoV-2 can help identify presymptomatic or asymptomatic individuals, especially in areas where COVID-19 is prevalent. Negative results, however, do not preclude COVID-19 and should not be used as the sole basis for patient management decisions.
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