What about the others: differential diagnosis of COVID-19 in a German emergency department.
COVID-19
Clinical symptoms
Differential diagnosis
Emergency department
Respiratory infection
SARS-Cov-2
Triage
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
17 Sep 2021
17 Sep 2021
Historique:
received:
13
11
2020
accepted:
07
09
2021
entrez:
18
9
2021
pubmed:
19
9
2021
medline:
25
9
2021
Statut:
epublish
Résumé
The ongoing COVID-19 pandemic remains a major challenge for worldwide health care systems and in particular emergency medicine. An early and safe triage in the emergency department (ED) is especially crucial for proper therapy. Clinical symptoms of COVID-19 comprise those of many common diseases; thus, differential diagnosis remains challenging. We performed a retrospective study of 314 ED patients presenting with conceivable COVID-19 symptoms during the first wave in Germany. All were tested for COVID-19 with SARS-Cov-2-nasopharyngeal swabs. Forty-seven patients were positive. We analyzed the 267 COVID-19 negative patients for their main diagnosis and compared COVID-19 patients with COVID-19 negative respiratory infections for differences in laboratory parameters, symptoms, and vital signs. Among the 267 COVID-19 negative patients, 42.7% had respiratory, 14.2% had other infectious, and 11.2% had cardiovascular diseases. Further, 9.0% and 6.7% had oncological and gastroenterological diagnoses, respectively. Compared to COVID-19 negative airway infections, COVID-19 patients showed less dyspnea (OR 0.440; p = 0.024) but more dysgeusia (OR 7.631; p = 0.005). Their hospital stay was significantly longer (9.0 vs. 5.6 days; p = 0.014), and their mortality significantly higher (OR 3.979; p = 0.014). For many common ED diagnoses, COVID-19 should be considered a differential diagnosis. COVID-19 cannot be distinguished from COVID-19 negative respiratory infections by clinical signs, symptoms, or laboratory results. When hospitalization is necessary, the clinical course of COVID-19 airway infections seems to be more severe compared to other respiratory infections. German Clinical Trial Registry DRKS, DRKS-ID of the study: DRKS00021675 date of registration: May 8th, 2020, retrospectively registered.
Sections du résumé
BACKGROUND
BACKGROUND
The ongoing COVID-19 pandemic remains a major challenge for worldwide health care systems and in particular emergency medicine. An early and safe triage in the emergency department (ED) is especially crucial for proper therapy. Clinical symptoms of COVID-19 comprise those of many common diseases; thus, differential diagnosis remains challenging.
METHOD
METHODS
We performed a retrospective study of 314 ED patients presenting with conceivable COVID-19 symptoms during the first wave in Germany. All were tested for COVID-19 with SARS-Cov-2-nasopharyngeal swabs. Forty-seven patients were positive. We analyzed the 267 COVID-19 negative patients for their main diagnosis and compared COVID-19 patients with COVID-19 negative respiratory infections for differences in laboratory parameters, symptoms, and vital signs.
RESULTS
RESULTS
Among the 267 COVID-19 negative patients, 42.7% had respiratory, 14.2% had other infectious, and 11.2% had cardiovascular diseases. Further, 9.0% and 6.7% had oncological and gastroenterological diagnoses, respectively. Compared to COVID-19 negative airway infections, COVID-19 patients showed less dyspnea (OR 0.440; p = 0.024) but more dysgeusia (OR 7.631; p = 0.005). Their hospital stay was significantly longer (9.0 vs. 5.6 days; p = 0.014), and their mortality significantly higher (OR 3.979; p = 0.014).
CONCLUSION
CONCLUSIONS
For many common ED diagnoses, COVID-19 should be considered a differential diagnosis. COVID-19 cannot be distinguished from COVID-19 negative respiratory infections by clinical signs, symptoms, or laboratory results. When hospitalization is necessary, the clinical course of COVID-19 airway infections seems to be more severe compared to other respiratory infections.
TRIAL REGISTRATION
BACKGROUND
German Clinical Trial Registry DRKS, DRKS-ID of the study: DRKS00021675 date of registration: May 8th, 2020, retrospectively registered.
Identifiants
pubmed: 34535095
doi: 10.1186/s12879-021-06663-x
pii: 10.1186/s12879-021-06663-x
pmc: PMC8446739
doi:
Banques de données
DRKS
['DRKS00021675']
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
969Informations de copyright
© 2021. The Author(s).
Références
Euro Surveill. 2020 Jan;25(3):
pubmed: 31992387
Lancet. 2020 Mar 28;395(10229):1054-1062
pubmed: 32171076
Ann Intern Med. 2020 Sep 1;173(5):362-367
pubmed: 32491919
J Med Virol. 2020 Nov;92(11):2272-2273
pubmed: 32530534
Otolaryngol Head Neck Surg. 2020 Jul;163(1):3-11
pubmed: 32369429
BMJ. 2020 May 22;369:m1966
pubmed: 32444366
Clin Infect Dis. 2020 Nov 19;71(16):2246-2248
pubmed: 32306042
Int J Emerg Med. 2020 Aug 20;13(1):44
pubmed: 32819266
MMWR Morb Mortal Wkly Rep. 2020 Jun 19;69(24):759-765
pubmed: 32555134
JAMA. 2020 Apr 7;323(13):1239-1242
pubmed: 32091533
Lancet. 2020 Feb 15;395(10223):514-523
pubmed: 31986261
Clin Infect Dis. 2021 Feb 1;72(3):490-494
pubmed: 32556328
JAMA. 2020 Mar 17;323(11):1061-1069
pubmed: 32031570
CMAJ. 2021 Mar 22;193(12):E410-E418
pubmed: 33568436
N Engl J Med. 2020 Apr 30;382(18):1708-1720
pubmed: 32109013
Respir Med. 2013 Jul;107(7):1101-11
pubmed: 23660396
N Engl J Med. 2020 Jun 11;382(24):2372-2374
pubmed: 32302078
Respir Res. 2020 Jul 28;21(1):198
pubmed: 32723327
Ann Intern Med. 2020 Aug 18;173(4):268-277
pubmed: 32374815
JAMA Intern Med. 2020 Jul 1;180(7):934-943
pubmed: 32167524
MMWR Morb Mortal Wkly Rep. 2020 Feb 14;69(6):166-170
pubmed: 32053579
Open Forum Infect Dis. 2021 May 05;8(6):ofab201
pubmed: 34099978