Association between initial symptoms and subsequent hospitalization in outpatients with COVID-19: A cohort study

Abstract

Background: Most individuals with coronavirus disease 2019 (COVID-19) experience mild symptoms and are managed in the outpatient setting. The aim of this study was to determine whether self-reported symptoms at the time of diagnosis can identify patients at risk of clinical deterioration. Methods: This was a retrospective cohort study of 671 outpatients with laboratory-confirmed COVID-19 diagnosed in Toronto between March 1 and October 16, 2020. We examined the association between patients’ baseline characteristics and self-reported symptoms at the time of diagnosis and the risk of subsequent hospitalization. Results: Of 671 participants, 26 (3.9%) required hospitalization. Individuals aged 65 years or older were more likely to require hospitalization (OR = 5.29, 95% CI 2.19 to 12.77), whereas those without medical comorbidities were unlikely to be hospitalized (OR = 0.02, 95% CI 0.00 to 0.17). After adjusting for age and presence of comorbidities, sputum production (adjusted OR [aOR] = 5.01, 95% CI 1.97 to 12.75), arthralgias (aOR = 4.82, 95% CI 1.85 to 12.53), diarrhea (aOR = 4.56, 95% CI 1.82 to 11.42), fever (aOR = 3.64, 95% CI 1.50 to 8.82), chills (aOR = 3.62, 95% CI 1.54 to 8.50), and fatigue (aOR = 2.59, 95% CI 1.04 to 6.47) were associated with subsequent hospitalization. Conclusions: Early assessment of symptoms among outpatients with COVID-19 can help identify individuals at risk of clinical deterioration. Additional studies are needed to determine whether more intense follow-up and early intervention among high-risk individuals can alter the clinical trajectory of and outcomes among outpatients with COVID-19.

Characterizing Risk Factors for Hospitalization and Clinical Characteristics in a Cohort of COVID-19 Patients Enrolled in the GENCOV Study

“…In addition to patient characteristics, COVID-19 symptoms are also suggested to have prognostic value [36]. Symptoms including shortness of breath and fever were shown to be associated with hospitalization, and they have similarly been found to be common clinical presentations among those with severe illness by other studies [12,37]. Conversely, loss of smell was identified as the only symptom more prevalent among outpatients of our study and is suggested to be an early predictor of mild COVID-19 given its potential link to rapid antiviral responses within the nasal epithelium [38].…”

Use of a rapid triage assessment tool to discriminate the need for hospitalisation in patients with severe COVID-19 infection presenting to an outpatient clinic: a single-centre, prospective cohort study

“…One question that remains is how to choose a priori among those with severe COVID-19 who will most likely require treatment in a more intensive setting 36 40–45. Most published models only include demographic data such as age, gender, race and comorbidities, and use all COVID-19 positive subjects, irrespective of symptomatology, to develop and calibrate the model 42 44 45.…”

“…One question that remains is how to choose a priori among those with severe COVID-19 who will most likely require treatment in a more intensive setting 36 40–45. Most published models only include demographic data such as age, gender, race and comorbidities, and use all COVID-19 positive subjects, irrespective of symptomatology, to develop and calibrate the model 42 44 45. Our model, by contrast, was developed only in outpatients presenting with severe COVID-19 infections where a decision had to be made to refer to the hospital or continue to manage them as outpatients.…”

Evaluating the impact of a virtual outpatient care programme in preventing hospitalizations, emergency department visits and mortality for patients with COVID-19: a matched cohort study

“…( 8 ) Follow-up virtual visits were scheduled regularly, with more frequent visits arranged for patients identified as high risk of severe disease; in the first wave all patients were followed until the end of their isolation period, but in subsequent waves routine follow-up was only arranged for higher risk patients. ( 9 ) Oxygen-saturation monitoring devices were couriered to high-risk patients. ( 10 ) Patients were counselled to notify COVIDEO if they had significant decrease in oxygen saturation levels or subjective dyspnea.…”