Clinical, laboratory, and radiological features indicative of novel coronavirus disease (COVID-19) in emergency departments: a multicenter case-control study in Hong Kong.

ABSTRACT

Objectives: Little is known about the value of routine clinical assessment in identifying patients with coronavirus disease 2019 (COVID-19) in the emergency department (ED). We aimed to compare the exposure history, signs and symptoms, laboratory, and radiographic features of ED patients who tested positive and negative for COVID-19. Methods: This was a case-control study in 7 EDs in Hong Kong from 20 January to 29 February 2020. Thirty-seven patients with laboratory-confirmed COVID-19 were age- and sex-matched to 111 controls. We compared the groups with univariate analysis and calculated the odds ratio (OR) of having COVID-19 for each characteristic that was significantly different between the groups with adjustment for age and presumed location of acquiring the infection. Results: There were no significant differences in patient characteristics and reported symptoms between the groups. A positive contact history within 14 days (adjusted OR 37.61, 95% CI 10.86-130.19), bilateral chest radiograph shadow (adjusted OR 13.19, 95% CI 4.66-37.35), having prior medical consultation (adjusted OR 7.43, 95% 2.89-19.09), a lower white blood cell count (adjusted OR 1.30, 95% CI 1.11-1.51), and a lower platelet count (adjusted OR 1.07, 95% CI 1.01-1.12) were associated with a higher odds of COVID-19 separately. A higher neutrophil count was associated with a lower odds of COVID-19 (adjusted OR 0.77, 95% CI 0.65-0.91). Conclusion: This study highlights a number of clinical features that may be useful in identifying high-risk patients for early testing and isolation while waiting for the test result. Further studies are warranted to verify the findings.