Initial Signs and Symptoms in Suspected Patients Admitted to Triage Outpatient Clinic of Coronavirus Disease 2019 (COVID-19): A Single-Center Experience

Year 2022, Volume: 14 Issue: 1, 146 - 151, 14.03.2022

Yusuf Çetin Doğaner , Ümit Kaplan Ümit Aydoğan , Aysun Yalçı Mine Filiz Hatice Turhan Sevgi Sökülmez Yıldırım , Uğur Bozlar , İsmail Yaşar Avcı , Mustafa Taşar

https://doi.org/10.18521/ktd.1052381

Abstract

Objective: Coronavirus disease (COVID‐19) is a worldwide pandemic with a huge burden of illness, high economic costs, and mortality rates. This study sought to compare clinical signs and symptoms among adult COVID‐19 patients admitted to triage outpatient clinics.
Methods: In this observational retrospective study, clinical symptoms, biochemical parameters, and chest computed tomography (CT) of 1745 suspected patients admitted to COVID-19 triage outpatient clinic between 01 April 2020-01 September 2020 were analyzed.
Results: A total of 650 (37.2%) of 1745 patients who were admitted to triage outpatient clinic were diagnosed as COVID-19 by PCR confirmation. Of the participants, 88.1% had at least one symptom, 11.9% were asymptomatic. Almost half of the patients (50.1%) had a history of exposure including contact with COVİD-19 confirmed cases. COVID-19 (+) patients were more diabetic and hypertensive than negative cases. In patients who underwent chest CT imaging, 40.6% (310) had pneumonic infiltrations compatible with COVID-19 pneumonia. Hemoglobin, leukocyte, neutrophil, lymphocyte, and platelet counts were lower, but CRP levels were higher in patients with COVID-19. Multivariate logistic regression analysis revealed that older age (OR=1.020; p=0.018), contact with confirmed COVID-19 patient (OR=1.907, p=0.009), fever (OR=1,588, p=0,001), fatigue (OR=2.075, p=0.009), cough (OR= 2.301, p<0.001) were significantly associated with increased odds of PCR (+) status.
Conclusion: Predictive factors associated with PCR (+) test results were older age, history of contact with confirmed COVID-19 patient, high fever, fatigue, cough in our study. Some symptoms could have a significant relationship with PCR positivity, which requires a more careful approach during the first admission to healthcare facilities.

Keywords

COVID-19 virus, Polymerase Chain Reaction, Signs and Symptoms

Supporting Institution

None

Initial Signs and Symptoms in Suspected Patients Admitted to Triage Outpatient Clinic of Coronavirus Disease 2019 (COVID-19): A Single-Center Experience

Abstract

Objective: Coronavirus disease (COVID‐19) is a worldwide pandemic with a huge burden of illness, high economic costs, and mortality rates. This study sought to compare clinical signs and symptoms among adult COVID‐19 patients admitted to triage outpatient clinics.

Methods: In this observational retrospective study, clinical symptoms, biochemical parameters, and chest computed tomography (CT) of 1745 suspected patients admitted to COVID-19 triage outpatient clinic between 01 April 2020-01 September 2020 were analyzed.

Results: A total of 650 (37.2%) of 1745 patients who were admitted to the triage outpatient clinic were diagnosed as COVID-19 by PCR confirmation. Of the participants, 88.1% had at least one symptom, 11.9% were asymptomatic. Almost half of the patients (50.1%) had a history of exposure including contact with COVİD-19 confirmed cases. COVID-19 (+) patients were more diabetic and hypertensive than negative cases. In patients who underwent chest CT imaging, 40.6% (310) had pneumonic infiltrations compatible with COVID-19 pneumonia. Hemoglobin, leukocyte, neutrophil, lymphocyte, and platelet counts were lower, but CRP levels were higher in patients with COVID-19. Multivariate logistic regression analysis revealed that older age (OR=1.020; p=0.018), contact with confirmed COVID-19 patient (OR=1.907, p=0.009), fever (OR=1,588, p=0,001), fatigue (OR=2.075, p=0.009), cough (OR= 2.301, p<0.001) were significantly associated with increased odds of PCR (+) status.

Conclusion: Predictive factors associated with PCR (+) test results were older age, history of contact with confirmed COVID-19 patient, high fever, fatigue, cough in our study. Some symptoms could have a significant relationship with PCR positivity, which requires a more careful approach during the first admission to healthcare facilities.

Keywords

COVID-19 virus, Polymerase Chain Reaction, Signs and Symptoms

References

• 1. WHO Director-General’s opening remarks at the media briefing on COVID-19 - 11 March 2020 [Internet]. Available from:https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020.
• 2. Republic of Turkey Ministry of Health. Study of Scientific Board. COVID-19 (SARS-CoV-2 INFECTION) GUIDE [Internet]. 2020; Available from:https://hsgm.saglik.gov.tr/depo/birimler/goc_sagligi/covid19/rehber/COVID-19_Rehberi20200414_eng_v4_002_14.05.2020.pdf.
• 3. WHO Coronavirus (COVID-19) Dashboard | WHO Coronavirus (COVID-19) Dashboard With Vaccination Data [Internet]. Available from:https://covid19.who.int/.
• 4. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020;382(8):727–33.
• 5. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet (London, England). 2020;395(10223):497–506.
• 6. Şahin EM, Ocak Ö, Demiral C, Dönmez B. COVİD-19 Symptoms at First Admission to Hospital. Konuralp Tıp Derg. 2021;13(2):265–72.
• 7. Abobaker A, Raba AA, Alzwi A. Extrapulmonary and atypical clinical presentations of COVID-19. J Med Virol. 2020;92(11):2458–64.
• 8. Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents. 2020;55(3).
• 9. Pan F, Ye T, Sun P, Gui S, Liang B, Li L, et al. Time Course of Lung Changes at Chest CT during Recovery from Coronavirus Disease 2019 (COVID-19). Radiology. 2020;295(3):715–21.
• 10. Zhu W, Xie K, Lu H, Xu L, Zhou S, Fang S. Initial clinical features of suspected coronavirus disease 2019 in two emergency departments outside of Hubei, China. J Med Virol. 2020;92(9):1525–32.
• 11. Simsek Yurt N, Ocak M, Yurt YC. Epidemiological and clinical characteristics of 3334 cases with prediagnosis coronavirus disease - 2019 (COVID-19) in Turkey. Int J Clin Pract. 2021;75(10).
• 12. Covid19 [Internet]. Natl Wkly COVID-19 chart. Available from:https://covid19.saglik.gov.tr/.
• 13. Telli Dizman G. A COVID-19 First Evaluation Clinic at a University Hospital in Turkey. Turkish J Med Sci. 2021;
• 14. Augustin M, Schommers P, Suárez I, Koehler P, Gruell H, Klein F, et al. Rapid response infrastructure for pandemic preparedness in a tertiary care hospital: lessons learned from the COVID-19 outbreak in Cologne, Germany, February to March 2020. Euro Surveill. 2020;25(21).
• 15. Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol. 2020;146(1):110–18.
• 16. Piroth L, Cottenet J, Mariet AS, Bonniaud P, Blot M, Tubert-Bitter P, et al. Comparison of the characteristics, morbidity, and mortality of COVID-19 and seasonal influenza: a nationwide, population-based retrospective cohort study. Lancet Respir Med. 2021;9(3):251–59.
• 17. Zhang JJY, Lee KS, Ang LW, Leo YS, Young BE. Risk Factors for Severe Disease and Efficacy of Treatment in Patients Infected With COVID-19: A Systematic Review, Meta-Analysis, and Meta-Regression Analysis. Clin Infect Dis. 2020;71(16):2199–2206.
• 18. Mercan Y, Digin F, Bulut S. Common Symptoms in COVID-19 Confirmed Cases Followed-Up at Home by Primary Healthcare Services. Eurasian J Fam Med. 2021;10(3):115–24.
• 19. Ali MR, Hasan MA, Rahman MS, Billah M, Karmakar S, Shimu AS, et al. Clinical manifestations and socio-demographic status of COVID-19 patients during the second-wave of pandemic: A Bangladeshi experience. J Infect Public Health. 2021;14(10):1367–74.
• 20. Goyal P, Choi JJ, Pinheiro LC, Schenck EJ, Chen R, Jabri A, et al. Clinical Characteristics of Covid-19 in New York City. N Engl J Med. 2020;382(24):2372–74.
• 21. Chow YP, Chin BHZ, Loo JM, Moorthy LR, Jairaman J, Tan LH, et al. Clinical and epidemiological characteristics of patients seeking COVID-19 testing in a private centre in Malaysia: Is there a role for private healthcare in battling the outbreak? PLoS One. 2021;16(10):e0258671.
• 22. Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708–20.
• 23. Zhu J, Ji P, Pang J, Zhong Z, Li H, He C, et al. Clinical characteristics of 3062 COVID-19 patients: A meta-analysis. J Med Virol. 2020;92(10):1902–14.
• 24. Sun P, Qie S, Liu Z, Ren J, Li K, Xi J. Clinical characteristics of hospitalized patients with SARS-CoV-2 infection: A single arm meta-analysis. J Med Virol. 2020;92(6):612–17.
• 25. Tian S, Hu N, Lou J, Chen K, Kang X, Xiang Z, et al. Characteristics of COVID-19 infection in Beijing. J Infect. 2020;80(4):401–6.
• 26. Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis. 2020;94:91–95.
• 27. Cheng † W, Peng † Y, Zhou A, Lin L, Liao X, Deng D, et al. Comparative clinical characteristics among different age group of adult COVID‐19 patients: A multicenter study. Immunity, Inflamm Dis. 2021;
• 28. Nath Mondal R, Abdur Razzak Sarker M, Das A, Ahsanul Kabir Ahsan SM, Md Sarwer Jahan S, Sultana A, et al. Socio-demographic, clinical, hospital admission and oxygen requirement characteristics of COVID-19 patients of Bangladesh. medrxiv.org. .
• 29. Xie X, Zhong Z, Zhao W, Zheng C, Wang F, Liu J. Chest CT for Typical Coronavirus Disease 2019 (COVID-19) Pneumonia: Relationship to Negative RT-PCR Testing. Radiology. 2020;296(2):E41–45.
• 30. Wen Z, Chi Y, Zhang L, Liu H, Du K, Li Z, et al. Coronavirus Disease 2019: Initial Detection on Chest CT in a Retrospective Multicenter Study of 103 Chinese Patients. Radiol Cardiothorac imaging. 2020;2(2).
• 31. Yalçın, EE; Aydoğan, Ü; Doğaner Y. Pandemide Birinci Basamak Sağlık hizmetlerinde Labaratuvar ve Yönetimi. dergipark.org.tr. .
• 32. Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934–43.
• 33. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet (London, England). 2020;395(10229):1054–62.