Is the presence of a typical triad of COVID-19 symptoms (cough, dyspnea, and fever) enough to make a decision about diagnostic testing? From the perspective of an emergency department

Is the typical triad symptoms enough for COVID-19

Abstract

Objective: The aim of this study is to show the consistence between the recommended guidelines regarding the triad of symptoms—cough, dyspnea, and fever—and the diagnosis of COVID-19.

Methods: A prospective observational study conducted at a tertiary emergency department between April 2, 2020 and May 15, 2020 in Turkey. Detailed patient history, main presenting complaints and imaging findings were recorded. For COVID-19 confirmation, nasopharyngeal RT-PCR was used. The relationship between complaints and COVID-19 test results were analyzed.

Results: Of the 1226, suspected COVID-19 patients, 127 were positive, 471 were negative, and 628 were discharged without any tests. The most common presenting complaints of the COVID-19 positive patients were throat pain (25.2%), dyspnea (15%), cough (22%), malaise and fatigue (11.8%), and fever (8.7%). There was no statistically significant difference between the positive and negative test groups as they had fever (χ², p = 0.30), cough (χ², p = 0.67) and dyspnea (χ², p = 0.14).

Conclusion: Considering that it is difficult to diagnose COVID-19 in emergency settings, testing decision and diagnosis should not depend only on classical symptoms; otherwise, patients with atypical and rare symptoms may be missed. Instead, patient history, clinical status, and radiological findings should be considered together.