Three hundred ninety-five patients were included. Nine patients were excluded because neither HRCT chest, nor PCR testing for COVID-19 was performed. In these patients, there was no time to perform PCR testing and HRCT chest would not be performed, since these were obstetric emergencies and children under 16 years of age.
In the residual 386 patients, 398 sets of screening results were available, and 200 patients were female (52%), with a median age of 60 years (range 4–98) (Table 1).
Three hundred eighty-six patients undergoing intervention from 11 different specialties were identified. In 16 cases (4%), surgery was delayed or the decision was made not to operate at all. This included five elderly patients with a femur fracture, in which the decision was made to implement a palliative treatment. Of the remaining 370 patients, 137 patients (37%) had an indication for emergency surgery. Most interventions were performed by surgeons (n = 208, 56%). General anaesthesia was the most commonly used type of anaesthesia (n = 216 times, 59%) (Table 2).
Of all 398 screenings, a symptom questionnaire was taken in 287 (72%) cases, including histories taken in the emergency department, where the questionnaire was not always completed (24 cases, 6%) as only coughing and shortness of breath were asked. In 24 patients, the questionnaire was negative, but exact answers were not noted. In geriatric admissions, cough, fever and dyspnoea are part of standard admission history taken on the ward. These results were scored when full symptom questionnaire was not taken (n = 16, 4% of histories). In screenings performed on 21 (5%) clinical patients, no symptom questionnaire was taken. These include seven repeated screenings for patients having repeat surgery due to complications. The symptom questionnaire was less often performed in emergency surgery compared to semi-elective surgery (49% versus 87% respectively).
Symptoms were reported during the questionnaire by 36 patients (9%), and no patients reported more than two symptoms. Fever was reported most, by 17 patients (4%). Least reported was loss of smell and taste, two times (1%) (Table 3).
All PCR tests (371 screenings) were negative. Three hundred eighty-six CT scans were performed on 374 patients. In 12 cases, no HRCT chest was performed, because of pregnancy or age under 16 years (Table 4). Three hundred sixty-seven (95%) of the HRCT chests were either negative (CO-RADS 1 or 2) or inconclusive (between CO-RADS 1 and 2, 6 cases). Six scans with unspecified CO-RADS were reviewed by radiologists. In one patient, the diagnosis changed to CO-RADS 3, but PCR was negative. The other patients were classified as CO-RADS 1 and 2.
In 18 cases total, CO-RADS 3 was found. Fifteen patients were discussed in the daily COVID MDT meeting. Three patients were not discussed, two had the intervention without extra PPE, and the other was screened before decision for palliative treatment without surgery was made. PCR testing on the others came back negative. In six cases, the MDT conclusion had impact on the surgical management and one patient was transferred to another hospital due to underlying disease. The other eight patients were operated without extra PPE as their PCR testing was negative (Fig. 2).
Of the 398 screenings, ten were double screenings, and one patient had three screenings, making twelve double screenings (Fig. 2). In three of the patients with double screening, surgery was delayed due to pre-operative optimisation or logistic reasons and screening had to be repeated because the 48-h window of valid screening results had passed. Seven patients had a second screening due to repeat surgery, and one patient had two more screenings and subsequent surgeries due to complications. In one patient, PCR testing was not performed in the second screening. CO-RADS score was different in two patients (CO-RADS 2 to CO-RADS 1 and CO-RADS 2 to CO-RADS 3) on repeated HRCT chest, and this seemed due to interobserver variation.
In 55 (14% of scans) patients, 56 incidental findings were made (Table 4). In total, nine abnormalities suspect for malignancy were found, together with two scans indicating metastatic disease with unknown primary tumour (20% of findings). An aortic aneurysm was found in three patients (5%). A total of 20 pulmonary nodules requiring follow-up were found, ranging from benign to malignant, constituting 36% of findings and 5% of all HRCT chests performed. In one patient, a colon carcinoma was found in addition to the pulmonary nodules. In case of an incidental finding, the attending physician was notified.
Four patients developed for COVID-19 suspected symptoms post-operatively, after which repeat PCR testing came back positive. Three had negative screening before surgery. In one patient, CO-RADS 3 was reported pre-operative. In COVID-MDT, this patient was rated as not suspicious given a negative PCR and lack of symptoms and was treated as COVID negative in theatre.
These four patients were aged 87–91 years, and all received surgery for a subcapital femoral neck fracture and were admitted to the geriatric department. One patient only experienced a mild sore throat and was tested before discharge to a nursing home. One patient, the only male of the four, went into a post-operative delirium, after which palliative management was started and patient died within one day. PCR testing came back positive afterwards. One patient developed symptoms in the nursing home after discharge and was diagnosed there. The last patient experienced dyspnoea and was tested positive.