Clinical Suspicion of COVID-19 in Nursing Home Residents: Symptoms and Mortality Risk Factors

Abstract

Objectives To describe symptomatology, mortality and risk factors for mortality in a large group of Dutch nursing home (NH) residents with clinically-suspected COVID-19 who were tested with a Reverse Transcription Polymerase Chain Reaction (RT-PCR) test. Design Prospective cohort study. Setting and participants Residents of Dutch NHs with clinically-suspected COVID-19 and who received RT-PCR test. Methods We collected data of NH residents with clinically-suspected COVID-19, via electronic health records between March 18 th and May 13 th , 2020. Registration was performed on diagnostic status (confirmed (COVID-19+)/ruled out (COVID-19-)) and symptomatology (typical and atypical symptoms). Information on mortality and risk factors for mortality were extracted from usual care data. Results In our sample of residents with clinically-suspected COVID-19 (N=4007), COVID-19 was confirmed in 1538 residents (38%). Although, symptomatology overlapped between residents with COVID-19+ and COVID-19-, those with COVID-19+ were three times more likely to die within 30 days (hazard ratio (HR), 3·1; 95% CI, 2·7 to 3·6). Within this group, mortality was higher for men than for women (HR, 1·8; 95%, 1·5-2·2) and we observed a higher mortality for residents with dementia, reduced kidney function, and Parkinson’s Disease, even when corrected for age, gender, and comorbidities. Conclusions and implications About 40% of the residents with clinically-suspected COVID-19 actually had COVID-19, based on the RT-PCR test. Despite an overlap in symptomatology, mortality rate was three times higher for residents with COVID-19+. This emphasizes the importance of using low-threshold testing in NH residents which is an essential prerequisite to using limited personal protective equipment and isolation measures efficiently.

Clinical Presentation, Course, and Risk Factors Associated with Mortality in a Severe Outbreak of COVID-19 in Rhode Island, USA, April–June 2020

“…The clinical characteristics observed in this LTCF cohort are notable in the context of the large cluster of infected and high mortality rate, among the highest reported in current literature to our knowledge [ 14 ]. Incidence, demographic associations [ 20 ], transmission and symptom status [ 9 , 10 , 11 , 12 , 13 , 15 , 16 , 19 ], and atypical presentation [ 17 , 18 , 21 ] in LTCF residents are widely discussed in the literature [ 14 ]. Less attention was paid to the clinical patterns of COVID-19 in LTCF residents, as it relates to mortality outcomes, and those that did were not in exclusively outpatient settings [ 22 , 23 ].…”

“…Existing studies on COVID-19 outbreaks in the institutionalized elderly largely focus on epidemiological characteristics [ 9 , 10 , 11 , 12 ] and clinical symptoms related to initial presentation and transmission [ 13 , 14 , 15 , 16 , 17 , 18 ]. Few studies assessed the clinical course and past initial symptom status of residents, as it relates to mortality outcomes [ 19 , 20 , 21 ], especially in a non-hospital setting [ 22 , 23 ], with an infection and mortality rate as high as those documented here. In this study, we report a COVID-19 outbreak among 116 residents of a nursing home with a very high infection and mortality rates, with a specific focus on the clinical presentation and characteristics associated with mortality.…”

How Typical is the Spectrum of COVID-19 in Nursing Home Residents?

“…The observed mortality rate (36.4%) and the increased 4-week mortality risk in male residents and residents with dementia are confirmed by recently published studies. 7 , 8 , 9 These findings may serve as point of departure for future studies on prognostic factors.…”

“…Because we actively searched for this broad range of signs/symptoms (at presentation as well as over the disease course), our results complement studies on symptomatology in nursing home residents. 6 , 7 , 8 , 9…”

Parkinson's disease may worsen outcomes from coronavirus disease 2019 (COVID-19) pneumonia in hospitalized patients: A systematic review, meta-analysis, and meta-regression

“…A total of 297 records were excluded after screening the titles/abstracts because they did not match our inclusion and exclusion criteria. After evaluating 27 full-texts for eligibility, 8 full-text articles were excluded because they do not have the control/comparison group, 5 full-text articles were excluded because they do not have the outcome of interest (severe COVID-19 OR mortality), 2 full-text articles were excluded because the articles were not in English, and finally, 12 studies [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ] with a total of 103,874 COVID-19 patients were included in the meta-analysis ( Figure 1 ). Of a total of 12 included studies, 9 studies were retrospective cohort, 1 study was prospective cohort, 1 study was case-control study, while the remaining 1 study was a cross-sectional study.…”