Symptom- and Prevention-Based Testing of COVID-19 in Nursing Home Residents: A Retrospective Cohort Study

  1. Kelly C. Paap
  2. Anouk M. van Loon
  3. Sarian M. van Rijs
  4. Esther Helmich
  5. Bianca M. Buurman
  6. Martin Smalbrugge
  7. Cees M. P. M. Hertogh

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Abstract

Nursing homes (NH) residents with COVID-19 can either be tested because of presence of core symptoms (S-based) or because of transmission prevention (TP-based). The investigated study sample included all NH residents who underwent SARS-CoV-2 RT-PCR testing between March 16, 2020 and May 31, 2020 ( n = 380). Clinical symptoms, temperature, and oxygen saturation were extracted from medical records, 7 days before to 14 days after testing. COVID-19 was confirmed in 81 (21%) residents; 36 (44%) S-based and 45 (56%) TP-based: 45. Cycle threshold (CT) values did not differ between the groups. In the 7 days prior to the test falling (32%), somnolence (25%) and fatigue (21%) occurred in both groups. Two days before the test, we observed a stronger decrease in oxygen saturation and an increase in temperature for the S-based group compared to the T-based group that remained up to 10 days after testing. Residents within the S-based group were 2.5 times more likely to increased mortality within 30 days than residents in the TP-based group (HR, 2.56; 95% 1.3–5.2). Although, 73% of the T-based group did eventually develop core symptoms. Thus, attention to falling and daily measures of temperature and oxygen saturation can contribute to earlier detection.

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  1. Version published to 10.1177/23337214211055338
  2. ScreenIT

    SciScore for 10.1101/2020.10.28.20221275: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: Ethics: The Medical Ethics Committee of the Academic Medical Centre in Amsterdam approved the study protocol.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Data collection: Data about age, gender, BMI, type of ward, comorbidities and renal function of all residents that were tested on COVID-19 were extracted from the electronic health record (EHR) PinkRoccade Healthcare myCaress (myCaress).
    PinkRoccade Healthcare
    suggested: None
    All analyses were performed with the use of the SPSS statistical package, version 26.0 (SPSS, Armonk, NY: IBM Corp).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    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:
    This study had some limitations that must be acknowledged when interpreting results. The study was carried out within one organization and based on EHR data. Because of the use of EHR data we may have missed symptoms and also workload during the COVID-19 pandemia may have influenced symptom registration in the EHR negatively. As we used both care staff and physicians registration, this might have been somewhat overcome. Measuring the oxygen saturation and especially the temperature (tympanic and rectal) will not have been the same in every ward, but it is close to practice. A RT-PCR test has relatively low sensitivity (63-78%)22. Consequently we will have missed cases of COVID-19. Conclusions and Implications: Many LTCF residents with positive PCR did not have core symptoms when tested (fever, cough and dyspnea) but had other signs/symptoms at the day of testing and in the week before the positive test. Yet, a large part of this group, did develop these core symptoms after the testing day. Daily fluctuations in temperature and oxygen saturation can contribute to earlier detection. The results of this study underscore the importance of current testing policies that advice ample and repeated testing of all residents and personnel that are in close contact with a resident with confirmed COVID-19. This study shows that course profiles may be present. However, in order to substantiate this with more certainty, more research is needed that is prospective and longitudinal.

    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

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  3. Version published to 10.1101/2020.10.28.20221275v1 on medRxiv