Initial clinical features of suspected coronavirus disease 2019 in two emergency departments outside of Hubei, China

Abstract

With an increasing number of Coronavirus Disease 2019 (COVID-19) cases outside of Hubei, emergency departments (EDs) and fever clinics are facing challenges posed by the large number of admissions of patients suspected to have COVID-19. Therefore, it is of crucial importance to study the initial clinical features of patients, to better differentiate between infected and uninfected patients outside Hubei. A total of 116 patients suspected of having COVID-19 who presented to two emergency departments in Anhui for the first time between 24 January 2020 and 20 February 2020 were enrolled in the study. The initial clinical data of these patients, such as epidemiological features, symptoms, laboratory results, and chest computed tomography (CT) findings were collected using a standard case report form on admission. Thirty-two patients were diagnosed with COVID-19; the remaining 84 patients were referred to as negative cases. The median age of the diagnosed patients was 46 years, but only 35 years for negative cases. History of exposure to Wuhan or COVID-19 patients in the previous 2 weeks was observed in 63% of the diagnosed and 44% of negative cases. Median time from illness onset to ED admission was 5 days for all patients, diagnosed patients, and negative cases, respectively. Fever was observed in 27 (84%) and 57 (68%) diagnosed and negative cases, respectively. Nineteen (59%) diagnosed and 24 (29%) negative cases had lymphopenia on admission in ED. A chest CT scan on admission revealed the presence of pneumonia in the majority of the diagnosed patients (30 out of 32, 94%) and in 56 (67%) negative cases. Bilateral involvement and ground-glass opacity (GGO) were present in 91% and 47% of the diagnosed patients. Thirty-two patients were diagnosed with COVID-19; the remaining 84 patients were referred to as negative cases. The median age of the diagnosed patients was 46 years, but only 35 years for negative cases. History of exposure to Wuhan or COVID-19 patients in the previous 2 weeks was observed in 63% of the diagnosed and 44% of negative cases. Median time from illness onset to ED admission was 5 days for all patients, diagnosed patients, and negative cases, respectively. Fever was observed in 27 (84%) and 57 (68%) diagnosed and negative cases, respectively. Nineteen (59%) diagnosed and 24 (29%) negative cases had lymphopenia on admission in ED. A chest CT scan on admission revealed the presence of pneumonia in the majority of the diagnosed patients (30 out of 32, 94%) and in 56 (67%) negative cases. Bilateral involvement and GGO were present in 91% and 47% of the diagnosed patients.

Keywords: coronavirus; epidemiology; infection; virus classification.

Figure 1

Transverse chest CT from three patients suspected with COVID‐19 on admission in the emergency department. A, Computed tomography (CT) of A 47‐year‐old woman 3 days after illness onset, bilateral ground‐glass opacity was showed. She was diagnosed with COVID‐19; B, CT of A 33‐year‐old woman 7 days after illness onset, no specific CT findings were showed. She was diagnosed with COVID‐19; C, CT of A 21‐year‐old woman 3‐days after illness onset, showing ground‐glass opacity lower lobe of left lung. She was undiagnosed with COVID‐19