Symptoms and risk factors for hospitalization of COVID-19 presented in primary care

  1. Susanne Rabady
  2. Kathryn Hoffmann
  3. Markus Brose
  4. Oliver Lammel
  5. Stefanie Poggenburg
  6. Monika Redlberger-Fritz
  7. Karin Stiasny
  8. Maria Wendler
  9. Lukas Weseslindtner
  10. Sonja Zehetmayer
  11. Gustav Kamenski

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Abstract

Objective

To increase knowledge of discrete symptoms shall help to avoid misinterpretation of test results and to gain better understanding of associations between early symptoms and severe disease to provide additional criteria for targeted early interventions.

Design

Retrospective observational study.

Setting

Austrian GP practices in the year 2020, patients above 18 years were included.

Participants

We recruited 25 practices which included 295 participants with a positive SARS-CoV‑2 test.

Main outcome measures

Data collection comprised basic demographic data, risk factors and the recording of symptoms at several points in time in the course of the illness. Descriptive analyses for possible associations between demographics and symptoms were conducted by means of cross tabulation. Group differences (hospitalized yes/no) were assessed using Fisher’s exact test. The significance level was set to 0.05; due to the observational character of the study, no adjustment for multiplicity was performed.

Results

Only one third of patients report symptoms generally understood to be typical for COVID‑19. Most patients presented with unspecific complaints. We found symptoms indicating complicated disease, depending on when they appear. The number of symptoms may be a predictor for the need of hospital care. More than 50% of patients still experience symptoms 14 days after onset.

Conclusion

Unspecific symptoms are valuable indicators in the detection of early COVID‑19 disease that practitioners and the general public should be aware of also in the interpretation of low sensitivity tests. Monitoring patients using the indicators we identified may help to identify patients who are likely to profit from early intervention.

Article activity feed

  1. Version published to 10.1007/s00508-021-01992-y
  2. Version published to 10.1101/2021.03.26.21254331v3 on medRxiv
  3. Version published to 10.1101/2021.03.26.21254331v2 on medRxiv
  4. ScreenIT

    SciScore for 10.1101/2021.03.26.21254331: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: After the positive votum of the ethics committee practices interested in participating were informed about the aims of this study in detail and after agreement study material was provided.
    Consent: If they were willing to participate and after the provision of their written informed consent, they were included in the study.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and limitations of the study: This study to our knowledge is the first one to investigate data on the course of COVID-19 collected exclusively in a population presenting to primary care, predominantly (90%) unselected. Since we were not restricted to patients with a testing decision made beforehand like most other studies were, as elucidated by several studies (2, 7, 9, 10), we could follow the course of disease from day 1 in most cases. Only 10% approached primary care after having been tested according to testing criteria elsewhere. Those were followed retrospectively. Being conducted in primary we could oversee a wide range of patients, including patients presenting for symptoms they had not expected to be signs of COVID-19, e.g. back pain, headache, weakness, or common cold. The study has several limitations though. We could recruit 22 practices in 7 out of the 9 Austrian provinces. The practices included 7 (SD 5.9) patients on average into the study. This low response rate is probably due to the increased workload under difficult working conditions during the pandemic in combination with a rather extensive questionnaire and the need to follow patients over a period of time. Looking at this limited inclusion of positive cases we have to reckon with possible selection bias. Another limitation is not all data on symptoms were provided, particularly on fever. Most likely this applies mainly for symptoms which were not present, but this would have to be clarified by...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  5. Version published to 10.1101/2021.03.26.21254331v1 on medRxiv