Association between COVID-19 diagnosis and presenting chief complaint from New York City triage data

Abstract

Background and aim New York City (NYC) is an epicenter of the COVID-19 pandemic in the United States. Proper triage of patients with possible COVID-19 via chief complaint is critical but not fully optimized. This study aimed to investigate the association between presentation by chief complaints and COVID-19 status. Methods We retrospectively analyzed adult emergency department (ED) patient visits from five different NYC hospital campuses (hospital blinded) from March 1, 2020 to May 13, 2020 of patients who underwent nasopharyngeal COVID-19 RT-PCR testing. The positive and negative COVID-19 cohorts were then assessed for different chief complaints obtained from structured triage data. Sub-analysis was performed for patients older than 65 and within chief complaints with high mortality. Results Of 11,992 ED patient visits who received COVID-19 testing, 6524/11992 (54.4%) were COVID-19 positive. 73.5% of fever, 67.7% of shortness of breath, and 65% of cough had COVID-19, but others included 57.5% of weakness/fall/altered mental status, 55.5% of glycemic control, and 51.4% of gastrointestinal symptoms. In patients over 65, 76.7% of diarrhea, 73.7% of fatigue, and 69.3% of weakness had COVID-19. 45.5% of dehydration, 40.5% of altered mental status, 27% of fall, and 24.6% of hyperglycemia patients experienced mortality. Conclusion A novel high risk COVID-19 patient population was identified from chief complaint data, which is different from current suggested CDC guidelines, and may help triage systems to better isolate COVID-19 patients. Older patients with COVID-19 infection presented with more atypical complaints warranting special consideration. COVID-19 was associated with higher mortality in a unique group of complaints also warranting special consideration.

Contrastive learning improves critical event prediction in COVID-19 patients

“…EHR have already been used in biomedical research for disease and patient clustering, patient trajectory modeling, disease prediction, and clinical decision support, among others [4]. Recent studies discovered important findings to better understand COVID-19 through EHR-based analyses [5][6][7][8][9][10][11].…”

Syndromic surveillance: A key component of population health monitoring during the first wave of the COVID-19 outbreak in France, February-June 2020

“…Regarding severity in men, as suggested in several publications, it could be explained by different factors such as the immune system, sex hormones, physiological factors, sociocultural factors affecting health, and underlying comorbidities [ 17 , 19 , 20 ]. In our study, associated clinical symptoms or diagnoses were known to be strongly correlated to COVID-19 cases [ 21 , 22 ]. Early in the epidemic, these indicators were monitored as proxies due to the lack of specific ICD-10 codes and the scarcity of PCR tests to accurately identify visits related to this emergent disease.…”

“…Finally, phase 3 (since 14 March 2020) has involved population surveillance to reduce the dissemination of the virus within the population and mitigate its impact on the health care system [4]. From week 12 (16)(17)(18)(19)(20)(21)(22) to week 19 (4-10 May), a national lockdown was declared by the French government. At this time, health authorities advised the population to stay at home in the case of non-serious symptoms.…”

Real-world Effect of Monoclonal Antibody Treatment in COVID-19 Patients in a Diverse Population in the United States

“…visit or hospitalization after positive SARS-CoV-2 viral test result and was obtained from the electronic health record. A medical visit was COVID-related if one or more of the following chief complaints were identified: blood in sputum, chest congestion, chest pain, cough, COVID-19 screening, difficulty breathing, fever, flu-like symptoms, hypoxia, shortness of breath, sore throat, or weakness [20][21][22][23]. Dates of COVID-19 symptom onset and positive SARS-CoV-2 antigen test results performed at the infusion center were recorded on paper-based forms upon arrival of patients for mAb treatment, but were not recorded in electronic health records.…”