Signs, Symptoms, and Comorbidities Associated With Onset and Prognosis of COVID-19 in a Nursing Home.
Farrell A Tobolowsky, Ana C Bardossy, Dustin W Currie and 16 others
PMID 33549565WHAT IT FOUND
In a nursing home outbreak, most residents showed objective signs like abnormal vitals or oxygen changes at onset.
Hepatic disease, obesity, and CPAP use raised hospitalization risk, while oxygen changes predicted death. Typical symptoms alone missed cases.
Key findings
01Hepatic disease, obesity, and continuous positive airway pressure use were associated with increased risk of hospitalization.
02Change in oxygen status was associated with increased 30-day mortality.
03Most residents presented with at least one objectively observable sign, such as elevated temperature, change in mental status, lethargy, change in oxygen status, or cough, at illness onset.
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 retrospective and relied on the quality and completeness of documentation in one facility's electronic health records. Changes in care practices during the outbreak may have biased how symptoms were screened and documented. The study used medication orders rather than administrations, so it is unknown if residents actually received medications like antipyretics that could mask fever. The sample size was too small to adjust for potential confounding factors when examining relationships between comorbidities and outcomes. Findings may not be representative of all nursing home residents nationwide.
Declared interests
This activity was conducted as part of a public health response and was deemed nonhuman subjects research by the CDC.
The easy way to misread this
Do not assume that the absence of fever or cough rules out COVID-19 in nursing home residents, as sixty-three percent had at least one atypical symptom and eleven percent had only atypical symptoms during their illness.