Suggested investigations for suspect or confirmed COVID-19 patients under consideration for admission, or being admitted

 

1.  Laboratory tests: 

Laboratory tests may not be required in otherwise ambulatory patients who are clinically stable, and not felt to be at elevated risk of decompensation.  In the presence of higher clinical severity and/or comorbidities, the following laboratory tests may be considered:

  • CBC & differential - low lymphocyte count and/or neutrophil/lymphocyte ratio of >3.13 may be suggestive of COVID-19/more severe disease.
  • AST, ALT, bilirubin, creatinine, CRP
  • Blood cultures
  • COVID-19 PCR and RVP swabs OR sputum or ET aspirate for COVID-19 PCR

     Also consider for select patients:

  • HIVAb
  • Sputum (or endotracheal (ET) aspirate if intubated) for Gram stain and culture. NB:  Do not do bronchoscopy only to procure specimens.
  • MRSA nasal swab (to determine need for empiric MRSA pneumonia coverage pending cultures)

2.  CXR  - AP (portable) or PA/LAT depending on site policies for ED based COVID-19 patients.

 

3.  Laboratory tests that can be considered in specific patients based on clinical status and comorbidities  (NB: the current literature does not support a specific role for these parameters in guiding clinical management but they may be useful in evolving prognostic models):

  • ABG
  • INR
  • D-dimer
  • fibrinogen
  • ferritin
  • troponin
  • If immunocompromised and clinically indicated, ET aspirate, bronchoscopy (if required), or induced sputum for PJP