Clinical manifestation, investigation, management and outcomes of COVID-19 in emergency departments: a systematic review and meta-analysis
Keywords:
COVID-19, Coronavirus, SARS-CoV-2, Clinical manifestation, Emergency departmentAbstract
Introduction: Emergency departments are the frontline for managing patients suspected of having coronavirus disease 2019 (COVID-19).
Objective: To review the clinical manifestation, investigation and management of patients with COVID-19 in the emergency department (ED) setting.
Methods: We searched PubMed, Scopus and the Cochrane Library databases for case reports, case series and cohorts exploring the clinical manifestation, investigation and management of patients presenting to emergency department. We conducted a systematic review of the included studies and a meta-analysis of the cohorts.
Results: We included 40 case reports, 14 case series and 12 cohort studies in this systematic review. Based on cohort studies, patients typically presented with a history of sick contact (46%, 95% CI 42-49) or recent travel (24%, 95% CI 11-37). Cough (79%, 95% CI 71-86%), fever (61%, 95% CI 40-81%) and shortness of breath (48%, 95% CI 36-61) were the most common chief complaints. Although rarely present in ED patients, decreased taste and smell significantly increase the probability of testing positive for COVID-19 (risk ratio 6.20; 95% CI 1.82-21.14). Several rare clinical presentations of COVID-19 include stroke and skin rashes. Gastrointestinal symptoms could be found in up to 10-20% of patients. Although initial vital signs were not different between those who tested positive and negative for COVID-19, the intubation rate in the ED was triple in those with COVID-19 (risk ratio 3.59; 95% CI 1.48-8.69). Notable investigations were lymphopenia (71%, 95% CI 64-78) and bilateral infiltration on chest X-ray (60%, 95% CI 57-63).
Conclusion: Patients with COVID-19 could present to EDs with typical respiratory symptoms as well as several unusual manifestations, including gastrointestinal, neurological and dermatological problems. Since the intubation rate tripled in those with COVID-19 compared to those without. Thus, emergency physicians should prepare for effective intubation while keeping patients and providers safe.
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