What about the others: differential diagnosis of COVID-19 in a German emergency department

Abstract

Background The ongoing COVID-19 pandemic remains a major challenge for worldwide health care systems and in particular emergency medicine. An early and safe triage in the emergency department (ED) is especially crucial for proper therapy. Clinical symptoms of COVID-19 comprise those of many common diseases; thus, differential diagnosis remains challenging. Method We performed a retrospective study of 314 ED patients presenting with conceivable COVID-19 symptoms during the first wave in Germany. All were tested for COVID-19 with SARS-Cov-2-nasopharyngeal swabs. Forty-seven patients were positive. We analyzed the 267 COVID-19 negative patients for their main diagnosis and compared COVID-19 patients with COVID-19 negative respiratory infections for differences in laboratory parameters, symptoms, and vital signs. Results Among the 267 COVID-19 negative patients, 42.7% had respiratory, 14.2% had other infectious, and 11.2% had cardiovascular diseases. Further, 9.0% and 6.7% had oncological and gastroenterological diagnoses, respectively. Compared to COVID-19 negative airway infections, COVID-19 patients showed less dyspnea (OR 0.440; p = 0.024) but more dysgeusia (OR 7.631; p = 0.005). Their hospital stay was significantly longer (9.0 vs. 5.6 days; p = 0.014), and their mortality significantly higher (OR 3.979; p = 0.014). Conclusion For many common ED diagnoses, COVID-19 should be considered a differential diagnosis. COVID-19 cannot be distinguished from COVID-19 negative respiratory infections by clinical signs, symptoms, or laboratory results. When hospitalization is necessary, the clinical course of COVID-19 airway infections seems to be more severe compared to other respiratory infections. Trial registration: German Clinical Trial Registry DRKS, DRKS-ID of the study: DRKS00021675 date of registration: May 8th, 2020, retrospectively registered.

WITHDRAWN: A gene expression-based diagnostic classifier for identification of severe COVID-19 and multisystem inflammatory syndrome in children (MIS-C)

“…Acute syndromes that can mimic MIS-C include Kawasaki disease 3 , toxic shock syndrome 3 , bacterial or viral sepsis 4 , and even non-infectious conditions such as congestive heart failure, whether or not directly related to MIS-C 16 . In contrast, acute illnesses that can mimic severe COVID-19 include many infections [17][18][19] , including those caused by respiratory viruses (e.g., influenza virus, parainfluenza virus, adenovirus, etc. ), bacterial pneumonia, including tuberculosis, malaria, and chronic obstructive pulmonary disease exacerbation.…”

Characteristics of eye-related emergency visits and triage differences by nurses and ophthalmologists: Perspective from a single eye center in southern China

“…Triage is an effective process for ensuring that effective emergency care is provided despite limited resources by sorting and prioritizing patients to appropriate orders for visits based on their urgency degree. Risk stratification is one of the central challenges of emergency medicine ( 5 – 7 ). Due to non-eye practitioners’ limited knowledge and training in ophthalmology, the problem of identifying vision-threatening patients is highlighted in ophthalmic emergencies ( 8 , 9 ).…”

“…Due to non-eye practitioners' limited knowledge and training in ophthalmology, the problem of identifying visionthreatening patients is highlighted in ophthalmic emergencies (8, 9). Historically, registered nurses have been the first line to perform triage in many countries' EDs (6). Previous studies have found that nurses in general EDs tend to assign patients to more urgent categories to avoid missing critical patients (10,11).…”

Applying fuzzy qualitative comparative analysis to identify typical symptoms of COVID-19 infection in a primary care unit, Rio de Janeiro, Brazil

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