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

David Fistera1,2, Annalena Härtl3, Dirk Pabst3

  • 1Center of Emergency Medicine, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany. David.fistera@uk-essen.de.

BMC Infectious Diseases
|September 18, 2021
PubMed

Insights

COVID-19 presented diagnostic challenges in emergency departments. COVID-19 patients experienced longer hospital stays and higher mortality than those with other respiratory infections.

Area of Science:

  • Emergency Medicine
  • Infectious Diseases
  • Clinical Diagnostics

Background:

  • COVID-19 pandemic poses significant challenges to healthcare systems, particularly emergency medicine.
  • Accurate and timely triage in the emergency department (ED) is critical for effective COVID-19 patient management.
  • Distinguishing COVID-19 symptoms from other common diseases in the ED is clinically challenging.

Purpose of the Study:

  • To compare clinical characteristics and outcomes of COVID-19 patients with non-COVID-19 patients presenting with similar symptoms.
  • To identify differences in laboratory parameters, symptoms, and vital signs between COVID-19 and non-COVID-19 respiratory infections.
  • To evaluate the severity of COVID-19 airway infections compared to other respiratory infections.

Main Methods:

  • Retrospective analysis of 314 patients with suspected COVID-19 symptoms in German emergency departments during the first wave.
  • RT-PCR testing for SARS-CoV-2 on nasopharyngeal swabs for all patients.
  • Comparison of laboratory parameters, symptoms, and vital signs between 47 COVID-19 positive patients and 267 COVID-19 negative patients, focusing on respiratory infections.

Main Results:

  • Among COVID-19 negative patients, respiratory diseases were the most common diagnosis (42.7%).
  • COVID-19 patients reported less dyspnea but more dysgeusia compared to COVID-19 negative respiratory infections.
  • COVID-19 patients had significantly longer hospital stays (9.0 vs. 5.6 days) and higher mortality (OR 3.979).

Conclusions:

  • COVID-19 should be considered in the differential diagnosis for various emergency department presentations.
  • Clinical signs, symptoms, and laboratory results alone cannot reliably differentiate COVID-19 from other respiratory infections.
  • COVID-19 airway infections appear to have a more severe clinical course requiring hospitalization compared to other respiratory infections.
Abstract

Keywords:
COVID-19Clinical symptomsDifferential diagnosisEmergency departmentRespiratory infectionSARS-Cov-2Triage

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