Original Study
Clinical Suspicion of COVID-19 in Nursing Home Residents: Symptoms and Mortality Risk Factors

https://doi.org/10.1016/j.jamda.2020.10.034Get rights and content

Abstract

Objectives

To describe the symptomatology, mortality, and risk factors for mortality in a large group of Dutch nursing home (NH) residents with clinically suspected COVID-19 who were tested with a reverse transcription–polymerase chain reaction (RT-PCR) test.

Design

Prospective cohort study.

Setting and Participants

Residents of Dutch NHs with clinically suspected COVID-19 and who received RT-PCR test.

Methods

We collected data of NH residents with clinically suspected COVID-19 via electronic health records between March 18 and May 13, 2020. Registration was performed on diagnostic status [confirmed (COVID-19+)/ruled out (COVID-19–)] and symptomatology (typical and atypical symptoms). Information on mortality and risk factors for mortality were extracted from usual care data.

Results

In our sample of residents with clinically suspected COVID-19 (N = 4007), COVID-19 was confirmed in 1538 residents (38%). Although symptomatology overlapped between residents with COVID-19+ and COVID-19–, those with COVID-19+ were 3 times more likely to die within 30 days [hazard ratio (HR), 3.1, 95% confidence interval (CI) 2.7-3.6]. Within this group, mortality was higher for men than for women (HR 1.8, 95% CI 1.5-2.2), and we observed a higher mortality for residents with dementia, reduced kidney function, and Parkinson's disease, even when corrected for age, gender, and comorbidities.

Conclusions and Implications

About 40% of the residents with clinically suspected COVID-19 actually had COVID-19, based on the RT-PCR test. Despite an overlap in symptomatology, mortality rate was 3 times higher for residents with COVID-19+. This emphasizes the importance of using low-threshold testing in NH residents, which is an essential prerequisite to using limited personal protective equipment and isolation measures efficiently.

Keywords

Long-term care facility
SARS-CoV-2
cohort
survival analyses

Cited by (0)

This study was funded by the Dutch Ministry of Health, Welfare and Sport.

The authors declare no conflicts of interest.

J.J.S. Rutten and A. M. van Loon contributed equally to the study.

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