Clinical Suspicion of COVID-19 in Nursing Home Residents: Symptoms and Mortality Risk Factors.
Jeanine J S Rutten, Anouk M van Loon, Janine van Kooten and 4 others
PMID 33256958WHAT IT FOUND
Among suspected nursing home residents with test results, 38% had confirmed COVID-19.
Fever was more common in confirmed cases, but symptoms overlapped. Confirmed cases had 42% 30-day mortality, especially among men and residents with dementia, reduced kidney function or Parkinson's disease.
Key findings
01Of 4007 residents with suspected COVID-19 and available test results, 1538 (38%) were confirmed and 2469 (62%) were ruled out.
02Fever was more common in confirmed residents (63%) than in ruled-out residents (42%), but shortness of breath and sore throat were more common in ruled-out residents.
03Confirmed residents had 42% 30-day mortality, compared with 15% in ruled-out residents, and were 3 times more likely to die within 30 days after adjustment.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was observational, so it cannot prove that confirmed infection caused the higher mortality or that any specific symptom caused death. RT-PCR testing has reported sensitivity of 63% to 78%, so some residents in the ruled-out group may actually have had COVID-19. Early in the outbreak, testing was limited by guideline changes, so the study could not properly describe asymptomatic or atypical presentations. Symptoms and comorbidities were recorded by physicians in an electronic health record, not independently assessed, and some data were missing. Comorbidities were extracted from free-text medical history using keyword searches, which can misclassify conditions. The ruled-out group had symptoms too, so other infections may have contributed to outcomes.
The easy way to misread this
Do not conclude that fever, cough, or shortness of breath reliably separates confirmed from ruled-out COVID-19 in nursing home residents. Many ruled-out residents had the same symptoms, and RT-PCR testing may have missed some infections.