Mockler Gretchen L, Novotny Samantha P, Hou Wei, Liu Yuhang, Schoenfeld Elinor R
Department of Family, Population & Preventive Medicine, Renaissance School of Medicine, Stony Brook University Hospital, Stony Brook, New York.
Renaissance School of Medicine, Stony Brook University Hospital, Stony Brook, New York.
AJPM Focus. 2022 Sep;1(1):100005. doi: 10.1016/j.focus.2022.100005. Epub 2022 May 12.
Most initial COVID-19 research focused on hospitalized patients. Presenting symptomatology in the outpatient setting was poorly characterized, making it difficult for primary care physicians to predict which patients would require hospitalization. The purpose of this study was to characterize the presenting symptoms of COVID-19 infection and baseline patient characteristics and evaluate for correlation with disease severity, duration, and chronicity in the outpatient setting.
A total of 107 adult, English-speaking patients with suspected and confirmed COVID-19 cases at the 3 primary care practices of Stony Brook University Hospital were studied between March and December 2020. Survey data were collected from patient telephone interviews and electronic medical record abstraction. The potential risk factors assessed included participant demographics, medical comorbidities, and the number and type of symptoms at illness onset. Outcome measures included symptom duration, hospitalizations, and persistence of symptoms at 12 weeks from study enrollment
Patient self-report survey elicited nearly twice as many symptoms described at illness onset as those recorded in the electronic medical record (<0.0001). A higher number of symptoms at illness onset was positively associated with symptom duration and chronicity. The presence of fever and hypoxia at the onset of illness were each positively associated with eventual hospitalization for COVID-19 disease.
Early in the setting of newly emerging infectious diseases, particularly those such as COVID-19 that involve multiple organ systems, patient self-report of symptoms using a complete review of systems rather than electronic medical record abstraction alone may be key for accurate disease identification and characterization as well as prediction of eventual disease severity, duration, and chronicity.
大多数最初的新冠病毒研究都集中在住院患者身上。门诊环境中的症状表现特征描述不足，这使得初级保健医生难以预测哪些患者需要住院治疗。本研究的目的是描述新冠病毒感染的症状表现和患者基线特征，并评估其与门诊环境中疾病严重程度、持续时间和慢性程度的相关性。
2020年3月至12月期间，对石溪大学医院3家初级保健机构中107例疑似和确诊新冠病毒病例的成年英语患者进行了研究。通过患者电话访谈和电子病历摘要收集调查数据。评估的潜在风险因素包括参与者的人口统计学特征、合并症以及发病时症状的数量和类型。结果指标包括症状持续时间、住院情况以及从研究入组起12周时症状的持续情况。
患者自我报告的调查显示，发病时描述的症状数量几乎是电子病历记录数量的两倍（<0.0001）。发病时症状数量较多与症状持续时间和慢性程度呈正相关。发病时发热和低氧血症均与最终因新冠病毒疾病住院呈正相关。
在新出现的传染病初期，尤其是像新冠病毒这样涉及多个器官系统的疾病，使用完整的系统回顾进行患者症状自我报告，而不仅仅是依靠电子病历摘要，对于准确识别和描述疾病以及预测最终疾病严重程度、持续时间和慢性程度可能至关重要。
