Assessment of Clinical Characteristics and Chest CT Findings of COVID-19 Prediagnosed Patients Admitted to the Emergency Department: A Retrospective Study

Abstract

Introduction: This study aimed to define the clinical features and laboratory findings that may be associated with COVID-19 pneumonia in patients with suspected COVID-19 pneumonia who presented to the emergency department in order to be able to recognize the disease early until molecular tests are available, and thus to isolate sick people as soon as possible. Patients and Methods: We retrospectively examined patients who were evaluated with the suspicion of COVID-19 between March 2020 and August 2020. We used the patient information management system to record patient demographic and clinical features, laboratory findings, and CT results. In subgroups with and without pneumonia, we compared these characteristics in confirmed COVID-19 patients. Results: Our study included 1,277 patients who were evaluated for suspected COVID-19. COVID-19 pneumonia was detected in 71.2% (n=210) of a total of 295 (23.4%) patients with a diagnosis of COVID-19 who were confirmed by RT-PCR positivity. Although 56.2% (n=18) of those with pneumonia were men, no statistically significant relationship was detected between gender distribution and CT findings (p=0.449). When we compared the patients in 3 subgroups according to age groups, it was observed that 59.4% (n=38) of those with negative CT findings were in the 18-44 age group, and 44.8% (n=94) of those with positive CT findings were 65 and over age group, and this distribution was found to be statistically significant (p<0.001). Pneumonia was detected in 58.3% (n=49) of COVID-19 cases (n=84) with a suspected exposure history (p=0.008). The most common symptoms in patients with positive CT findings (n=210) were fever (40.5% n=85) and fatigue (40.5% n=85), cough (32.9% n=69), and shortness of breath (28.6% n=60). The most common comorbidity in cases diagnosed with COVID-19 was HT (33.9%; n=100/295), followed by AF (19.3%; n=57/295), and the rates of HT and AF in those with COVID-19 pneumonia were statistically significantly higher compared to the CT-negative group (p<0.001 and p=0.002, respectively).COVID-19 pneumonia was more common in hospitalized patients (n=124), and hospitalization lengths were longer in both emergency and ICU admissions (p<0.001 and p=0.008). In our analysis in terms of the survival relationship, it was observed that 87.5% (n=35) of the COVID-19 cases who died had pneumonia (p<0.042). Low saturation and high respiratory rate per minute at the time of admission were associated with COVID-19 pneumonia (p<0.001). In the group with COVID-19 pneumonia, haemoglobin, GFR, and pCO2 values were recorded lower at the time of admission compared to patients with negative CT (p<0.001, p<0.001, p<0.05, respectively), while leukocytes, neutrophils, CRP, D-dimer, LDH, hs-troponin, AST and bilirubin were recorded as higher (p<0.05, p<0.01, p<0.001, p<0.001, p<0.001, p<0.001, p=0.01, p=0.01, respectively). Conclusion: Identifying patient features linked with COVID-19 pneumonia at the time of admission may influence our decision to have CT scans in emergency departments, regardless of the RT-PCR result, and may result in early disease identification and treatment.