Symptoms and risk factors for hospitalization of COVID-19 presented in primary care

Abstract

Summary Objective To increase knowledge of discrete symptoms shall help to avoid misinterpretation of test results and to gain better understanding of associations between early symptoms and severe disease to provide additional criteria for targeted early interventions. Design Retrospective observational study. Setting Austrian GP practices in the year 2020, patients above 18 years were included. Participants We recruited 25 practices which included 295 participants with a positive SARS-CoV‑2 test. Main outcome measures Data collection comprised basic demographic data, risk factors and the recording of symptoms at several points in time in the course of the illness. Descriptive analyses for possible associations between demographics and symptoms were conducted by means of cross tabulation. Group differences (hospitalized yes/no) were assessed using Fisher’s exact test. The significance level was set to 0.05; due to the observational character of the study, no adjustment for multiplicity was performed. Results Only one third of patients report symptoms generally understood to be typical for COVID‑19. Most patients presented with unspecific complaints. We found symptoms indicating complicated disease, depending on when they appear. The number of symptoms may be a predictor for the need of hospital care. More than 50% of patients still experience symptoms 14 days after onset. Conclusion Unspecific symptoms are valuable indicators in the detection of early COVID‑19 disease that practitioners and the general public should be aware of also in the interpretation of low sensitivity tests. Monitoring patients using the indicators we identified may help to identify patients who are likely to profit from early intervention.

S1 guidelines for the management of postviral conditions using the example of post-COVID-19

“…Eine Studie, die nach der Symptomatik vor und nach COVID-19 beim gleichen Individuum korrigiert, findet dagegen nur eine Häufigkeit von 12,7 % [ 31 ]. Grundsätzlich leiden die existierenden Vergleichsstudien zudem meist an den unzulänglichen Testkriterien, die zu Verzerrungen vor allem in Bezug auf falsch negative Personen in den Kontrollgruppen führen [ 32 , 33 ]. Dies führt auch zu erheblichen Limitierungen für Systematic Reviews, die an der sehr unterschiedlichen Methodik und Qualität der eingeschlossenen Studien leiden [ 27 , 34 ].…”

“…Dazu kommen die im Kapitel Epidemiologie bereits dargestellten methodischen Schwierigkeiten, die auch auf unzulänglichen Testungskriterien mit zu eng gestellter Indikation beruhen. Viele Personen wurden trotz Symptomatik nicht getestet (da diese nicht den zu engen Kriterien entsprach), andere Studien inkludieren klinische COVID-19-Diagnosen [ 31 – 33 ]. Daher sind alle Vergleichsstudien ohne zumindest serologischen COVID-19-Ausschluss eingeschränkt zuverlässig.…”

Development and validation of a risk prediction model for hospital admission in COVID-19 patients presenting to primary care

“…However, most patients initially contact their general practitioner (GP) and research initiatives in this specific setting could have the largest impact [ 3 ]. Risk assessment based on evaluating patient’s signs and symptoms can be complex and uncertain due to the highly variable clinical course of COVID-19 [ 4–6 ]. Multivariable prognostic models can help by providing patient-specific risks based on multiple predictors.…”

“We literally worked in parking lots, cars, garages, and separately set up party tents”: qualitative study on the experiences of GPs in the frame of the SARS-CoV-2 pandemic in Austria

“…hospitals and nursing homes [ 3 ], avoiding unnecessary consultations at different points of care reduces the risk of infection for the individual: testing, isolation and treatment of patients can be completed in a single setting [ 6 , 11 , 14 ]. Good surveillance can identify individuals at risk of complications and allow early intervention [ 15 ]. COVID-19-related conditions, such as post-acute sequelae of COVID-19 (PASC) [ 16 ], require appropriate attention and need to be managed primarily by generalists [ 17 , 18 ].…”