Symptoms and risk factors for hospitalization of COVID-19 presented in primary care : An exploratory retrospective study.

Susanne Rabady,Gustav Kamenski,Markus Brose,Oliver Lammel,Lukas Weseslindtner,Kathryn Hoffmann,Maria Wendler,Sonja Zehetmayer,Monika Redlberger-Fritz,Karin Stiasny,Stefanie Poggenburg

doi:10.1007/s00508-021-01992-y

Abstract

ObjectiveTo increase knowledge of discrete symptoms shall help to avoid misinterpretation of test results and to gain better understanding of associations between early symptoms and severe disease to provide additional criteria for targeted early interventions.DesignRetrospective observational study.SettingAustrian GP practices in the year 2020, patients above 18 years were included.ParticipantsWe recruited 25 practices which included 295 participants with a positive SARS-CoV‑2 test.Main outcome measuresData collection comprised basic demographic data, risk factors and the recording of symptoms at several points in time in the course of the illness. Descriptive analyses for possible associations between demographics and symptoms were conducted by means of cross tabulation. Group differences (hospitalized yes/no) were assessed using Fisher’s exact test. The significance level was set to 0.05; due to the observational character of the study, no adjustment for multiplicity was performed.ResultsOnly one third of patients report symptoms generally understood to be typical for COVID‑19. Most patients presented with unspecific complaints. We found symptoms indicating complicated disease, depending on when they appear. The number of symptoms may be a predictor for the need of hospital care. More than 50% of patients still experience symptoms 14 days after onset.ConclusionUnspecific symptoms are valuable indicators in the detection of early COVID‑19 disease that practitioners and the general public should be aware of also in the interpretation of low sensitivity tests. Monitoring patients using the indicators we identified may help to identify patients who are likely to profit from early intervention.Supplementary InformationThe online version of this article (10.1007/s00508-021-01992-y) contains supplementary material, which is available to authorized users.

Highlights

A central aspect in the containment of the coronavirus disease 2019 (COVID-19) pandemic is identification and isolation of possibly infectious persons, to prevent further spreading of the disease
Several studies were conducted with the goal of identifying diagnostic criteria that enable clinical differentiation between COVID-19 and non-COVID-19 infections: most investigations used data collected from hospitalized patients [1,2,3,4,5,6], i.e. from patients with severe disease
One of our findings is that none of the 13 symptoms in our selection is either sensitive or specific enough for the early stage of COVID-19 to serve as testing criteria, which is supported by several of the more recent studies based at least partly on data from primary care [7, 9]

Summary

Introduction

A central aspect in the containment of the coronavirus disease 2019 (COVID-19) pandemic is identification and isolation of possibly infectious persons, to prevent further spreading of the disease. Several studies were conducted with the goal of identifying diagnostic criteria that enable clinical differentiation between COVID-19 and non-COVID-19 infections: most investigations used data collected from hospitalized patients [1,2,3,4,5,6], i.e. from patients with severe disease These studies have found high prevalence of fever (around 90%), dyspnea (up to 50%), cough (60–70%), and fatigue in patients with COVID-19. All patients included in those studies had gone through a selection process before testing, by case definitions and testing criteria, by epidemiological factors or by previous investigations, such as computed tomography (CT) scans of the lungs.

Results

Discussion

Conclusion