Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin 7, Ireland.
School of Medicine, University College Dublin, Dublin 4, Ireland.
PLoS One. 2023 Aug 11;18(8):e0289245. doi: 10.1371/journal.pone.0289245. eCollection 2023.
The long-term effects of SARS-CoV-2 infection and optimal follow-up approach are not well-recognised. Here we describe the implementation of a post-COVID clinic in an Irish tertiary centre after the first wave of the pandemic. This study describes the characteristics of our patient cohort and the operations and outcomes of the clinic, exploring some of the risk factors for developing post-COVID syndrome and the appropriateness of the triage system employed.
All SARS-CoV-2 positive patients from March 10th to June 14th 2020 were telephone-triaged as red, amber or green based on ongoing symptoms with clinic appointments scheduled accordingly. All clinic visits were face-to-face with the infectious diseases medical team and a proforma for each patient was completed. Data were collected retrospectively by reviewing the proformas and the electronic medical record (EMR).
311 patients attended the clinic. Median time from illness to clinic appointment was 95 days (IQR 77-105.5). 204 patients (66%) were female, 192 (62%) were hospital staff, and the median age was 43 years (IQR 31-53). 138 patients (44%) had required hospital admission. At their first clinic visit 219 patients (70%) had ongoing symptoms. A further appointment was made for 62 patients (20%). 34 patients (11%) were discussed at an MDT meeting, and 55 (18%) were referred onward to a specialist service. 85% of those triaged green, 73% of those triaged amber, and 39% of those triaged red did not receive further follow up after one clinic visit. Patients were more likely to require follow up with reported dyspnoea (OR 5.6; 95% CI 2.8-11.3; p <0.001), cough (OR 3.0; 95% CI 1.1-8.4, p = 0.04), and palpitations (OR 3.6; 95% CI 1.0-12.3; p = 0.04). Female sex was associated with increased odds of a higher triage category (OR 1.8; 95% CI 1.08 to 3.20; p = 0.02), as was requiring admission to hospital (OR 4.0; 95% CI 2.34 to 6.90; p < 0.001).
The long-term effects of COVID-19 are significant with 70% of our cohort experiencing persistent symptoms. Persistent dyspnoea, cough and palpitations were associated with increased need for follow up. This study also suggests that a traffic light telephone-triage service followed by a face-to-face medical-led clinic could be an effective way of identifying patients who require further management.
SARS-CoV-2 感染的长期影响和最佳随访方法尚不清楚。在这里，我们描述了在大流行第一波之后，在爱尔兰的一个三级中心实施新冠病毒后诊所的情况。本研究描述了我们的患者队列的特征以及诊所的运作和结果，探讨了一些发生新冠病毒后综合征的风险因素以及所采用的分诊系统的适当性。
根据持续症状，所有 2020 年 3 月 10 日至 6 月 14 日期间的 SARS-CoV-2 阳性患者均通过电话进行红色、琥珀色或绿色分诊，并相应安排诊所预约。所有诊所就诊均由传染病医疗团队进行面对面就诊，并为每位患者填写表格。通过回顾表格和电子病历（EMR），回顾性收集数据。
共有 311 名患者就诊。从发病到就诊的中位时间为 95 天（IQR 77-105.5）。204 名患者（66%）为女性，192 名患者（62%）为医院工作人员，中位年龄为 43 岁（IQR 31-53）。138 名患者（44%）需要住院治疗。在第一次就诊时，219 名患者（70%）有持续症状。另有 62 名患者（20%）预约了进一步就诊。34 名患者（11%）在多学科会议上进行了讨论，35 名患者（11%）转介给专科服务。85%的绿色分类患者、73%的琥珀色分类患者和 39%的红色分类患者在一次就诊后不再接受进一步随访。有报告呼吸急促（OR 5.6；95%CI 2.8-11.3；p <0.001）、咳嗽（OR 3.0；95%CI 1.1-8.4，p = 0.04）和心悸（OR 3.6；95%CI 1.0-12.3；p = 0.04）的患者更有可能需要随访。女性（OR 1.8；95%CI 1.08-3.20；p = 0.02）和住院（OR 4.0；95%CI 2.34-6.90；p <0.001）与较高的分类类别几率相关。
COVID-19 的长期影响显著，我们队列中有 70%的患者持续出现症状。持续的呼吸急促、咳嗽和心悸与需要进一步随访的可能性增加有关。这项研究还表明，通过电话进行红绿灯分诊，然后进行面对面的医疗主导的诊所就诊，可以是一种有效的方法，以确定需要进一步管理的患者。
