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. 2020 Dec 3:12:451-457.
doi: 10.2147/OAEM.S275983. eCollection 2020.

Analysis of Symptoms of COVID-19 Positive Patients and Potential Effects on Initial Assessment

Felix Korell  1   2 , Evangelos Giannitsis  3 , Uta Merle  4 , Lars Philipp Kihm  1   5
Affiliations

Analysis of Symptoms of COVID-19 Positive Patients and Potential Effects on Initial Assessment

Felix Korell et al. Open Access Emerg Med. .

Abstract

Background: SARS-CoV-2 is a highly contagious virus, significantly impacting Germany among other countries since its emergence. Because of heterogeneous symptoms and a subset of patients even being asymptomatic at presentation, fast identification of infected patients remains challenging.

Objective: The goal of this study is the evaluation of different patient groups with a focus on symptoms and pre-existing illness at admission, as this is important for initial assessment and adequate emergency care.

Methods: COVID-19 positive patients at the University Hospital Heidelberg were retrospectively analyzed for disease history and symptoms at the initial presentation as well as mortality. The authors obtained institutional review board (IRB) approval by the Ethics Committee (Medical Faculty of Heidelberg University) prior to commencing the study.

Results: Dyspnea was more common in patients admitted to intermediate care/intensive care units (48 vs 13%, P<0.001) and showed a significantly higher percentage in the deceased (91 vs 48%, P=0.004). The symptoms of all presenting patients were highly variable, and many manifestations commonly associated with COVID-19 like cough, fever, and sore throat were only detected in a subset of patients, 60%, 43%, and 33%, respectively.

Conclusion: Dyspnea was present significantly more often in patients dying of COVID-19 compared to all patients admitted to the IMC/ICU, necessitating adequate observation and monitoring. In all presenting patients, initial symptoms showed large variation; therefore, COVID should be considered as a main differential diagnosis at every patient presentation, and patients with high pre-test probability should, if possible, be isolated until testing results are known.

Keywords: COVID-19; dyspnea; mortality; triage.

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Conflict of interest statement

Evangelos Giannitsis reports personal fees from AstraZeneca, grants from Roche Diagnostics, Daiichi Sankyo, and Brahms Thermo Fisher. The authors report no other potential conflicts of interest for this work.

Figures

Figure 1
Figure 1
Main symptoms at presentation sorted by admission status. Main symptoms, with which patients presented at admission, are shown for distribution in the investigated subgroups. *P<0.05, ***P<0.001.
Figure 2
Figure 2
Main symptoms at presentation for all intensive care patients and those later deceased. **P<0.01.
See this image and copyright information in PMC

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