JOURNAL ARTICLE

Initial clinical features of suspected Coronavirus Disease 2019 in two emergency departments outside of Hubei, China

Wanbo Zhu, Kai Xie, Hui Lu, Lei Xu, Shusheng Zhou, Shiyuan Fang
Journal of Medical Virology 2020 March 13
32167181

BACKGROUND: With an increasing number of Coronavirus Disease 2019 (COVID-19) cases outside of Hubei, emergency departments (EDs) and fever clinics are facing challenges posed by the large number of admissions of patients suspected to have COVID-19. Therefore, it is of crucial importance to study the initial clinical features of patients, to better differentiate between infected and uninfected patients outside Hubei.

METHODS: A total of 116 patients suspected of having COVID-19 who presented to two emergency departments in Anhui for the first time between 24 January 2020 and 20 February 2020 were enrolled in the study. The initial clinical data of these patients, such as epidemiological features, symptoms, laboratory results, and chest computed tomography findings were collected using a standard case report form on admission.

RESULTS: Thirty-two patients were diagnosed with COVID-19; the remaining 84 patients were referred to as negative cases. The median age of the diagnosed patients was 46 years, but only 35 years for negative cases. History of exposure to Wuhan or COVID-19 patients in the previous 2 weeks was observed in 63% of the diagnosed and 44% of negative cases. Median time from illness onset to ED admission was 5 days for all patients, diagnosed patients, and negative cases, respectively. Fever was observed in 27 (84%) and 57 (68%) diagnosed and negative cases, respectively. Nineteen (59%) diagnosed and 24 (29%) negative cases had lymphopenia on admission in ED. A chest CT scan on admission revealed the presence of pneumonia in the majority of the diagnosed patients (30 out of 32, 94%) and in 56 (67%) negative cases. Bilateral involvement and ground-glass opacity (GGO) were present in 91% and 47% of the diagnosed patients.

CONCLUSION: The initial clinical features of patients suspected of having COVID-19 in EDs outside Hubei were relatively mild. Meanwhile, diagnosed patients without definite exposure history tend to show more atypical initial clinical features in ED. No initial clinical feature was found to be specific to diagnosed patients, which could allow for early clinical diagnosis of COVID-19 in EDs. We recommend strict medical observation and quarantine of all patients suspected of having COVID-19, either in the ED itself or in a dedicated quarantine facility, irrespective of initial clinical features, especially in under-resourced regions without access to rapid nucleic acid amplification tests. This article is protected by copyright. All rights reserved.

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