ABSTRACT
BACKGROUND: The objective of the study was to identify clinical and demographic factors predictive of hospitalization in primary healthcare patients diagnosed with suspected COVID-19 at the beginning of the pandemic. METHODS: A retrospective cohort study design was used. Patients attended in Casanova primary healthcare centre (CAP) (Barcelona, Spain) for symptoms compatible with possible or confirmed SARS-CoV-2 infection between February 24 and May 30, 2020, were included. Data was collected through the electronic medical record and by telephone interview. RESULTS: 518 patients were included, of whom 283 (54.6%) were female. The median age was 50.2 years and 19.3% were aged ≥ 65 years: 79% were followed on an outpatient basis while the rest were hospitalized. Predictive factors for hospital admission were male sex, older age, a history of ischemic heart disease and the presence of dyspnoea, haemoptysis, nausea and vomiting, with a sensitivity of 48% and a specificity of 95.4%. Odynophagia and nasal congestion were predictors of a good prognosis. Mortality was 2.3% and 25% of deaths did not occur in hospital. CONCLUSIONS: Nearly 80% of primary healthcare patients received only outpatient care. Male sex, older age, a history of ischemic heart disease and symptoms like dyspnoea, haemoptysis, nausea and vomiting could lead to a greater risk of an unfavorable evolution during COVID-19. Patients with at least one of the above factors, which correlate with a higher hospital admission rate, should receive a closer follow-up to early detect when they can benefit from a hospital evaluation based on their clinical evolution.
ABSTRACT
BACKGROUND: The objective of the study was to identify clinical and demographic factors predictive of hospitalization in primary healthcare patients diagnosed with suspected COVID-19 at the beginning of the pandemic. METHODS: A retrospective cohort study design was used. Patients attended in Casanova primary healthcare centre (CAP) (Barcelona, Spain) for symptoms compatible with possible or confirmed SARS-CoV-2 infection between February 24 and May 30, 2020, were included. Data was collected through the electronic medical record and by telephone interview. RESULTS: 518 patients were included, of whom 283 (54.6%) were female. The median age was 50.2 years and 19.3% were aged ≥65 years: 79% were followed on an outpatient basis while the rest were hospitalized. Predictive factors for hospital admission were male sex, older age, a history of ischemic heart disease and the presence of dyspnoea, haemoptysis, nausea and vomiting, with a sensitivity of 48% and a specificity of 95.4%. Odynophagia and nasal congestion were predictors of a good prognosis. Mortality was 2.3% and 25% of deaths did not occur in hospital. CONCLUSIONS: Nearly 80% of primary healthcare patients received only outpatient care. Male sex, older age, a history of ischemic heart disease and symptoms like dyspnoea, haemoptysis, nausea and vomiting could lead to a greater risk of an unfavorable evolution during COVID-19. Patients with at least one of the above factors, which correlate with a higher hospital admission rate, should receive a closer follow-up to early detect when they can benefit from a hospital evaluation based on their clinical evolution. Resumen INTRODUCCIÓN: El objetivo del estudio fue identificar factores clínicos y demográficos predictivos de hospitalización en pacientes de atención primaria con diagnóstico de sospecha de COVID-19 al inicio de la pandemia. MÉTODOS: Cohorte retrospectiva, con pacientes atendidos en el centro de atención primaria (CAP) de Casanova (Barcelona, España) por síntomas compatibles con infección por SARS-CoV-2, entre 24 de febrero y 30 de mayo de 2020. Los datos se recogieron de la historia clínica electrónica y mediante entrevista telefónica. RESULTADOS: Se incluyeron 518 pacientes. 283 (54.6%) fueron mujeres. La edad media fue 50.2 años. Un 19.3% tenían 65 años o más. El 79% se siguieron de forma ambulatoria y el resto ingresaron en el hospital. Los factores predictivos de ingreso fueron sexo masculino, edad, antecedentes de cardiopatía isquémica y la presencia de disnea, hemoptisis, náuseas o vómitos, con una sensibilidad del 48% y una especificidad del 95.4%. Odinofagia y congestión nasal fueron factores predictores de buen pronóstico. La mortalidad fue del 2.3%. El 25% de los pacientes que fallecieron no lo hicieron en el ámbito hospitalario. CONCLUSIONES: Casi el 80% de los pacientes atendidos en Atención Primaria recibieron únicamente atención ambulatoria. Sexo masculino, edad avanzada, antecedente de cardiopatía isquémica y síntomas como disnea, hemoptisis, náuseas y vómitos, podrían conllevar un mayor riesgo de evolución desfavorable. Los pacientes con al menos uno de los factores anteriores, deben recibir un seguimiento más estrecho para detectar precozmente cuándo pueden beneficiarse de una evaluación hospitalaria en función de su evolución clínica.