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- Title
Age‐related differences in symptoms in older emergency department patients with COVID‐19: Prevalence and outcomes in a multicenter cohort.
- Authors
Goldberg, Elizabeth M.; Southerland, Lauren T.; Meltzer, Andrew C.; Pagenhardt, Justine; Hoopes, Ryan; Camargo, Carlos A.; Kline, Jeffrey A.
- Abstract
Background: Older adults represent a disproportionate share of severe COVID‐19 presentations and fatalities, but we have limited understanding of the differences in presentation by age and the association between less typical emergency department (ED) presentations and clinical outcomes. Methods: This retrospective cohort study used the RECOVER Network registry, a research collaboration of 86 EDs in 27 U.S. states. We focused on encounters with a positive nasopharyngeal swab for SARS‐CoV‐2, and described their demographics, clinical presentation, and outcomes. Sequential multivariable logistic regressions examined the strength of association between age cohort and outcomes. Results: Of 4536 encounters, median patient age was 55 years, 49% were women, and 34% were non‐Hispanic Black persons. Cough was the most common presenting complaint across age groups (18–64, 65–74, and 75+): 71%, 67%, and 59%, respectively (p < 0.001). Neurological symptoms, particularly altered mental status, were more common in older adults (2%, 11%, 26%; p < 0.001). Patients 75+ had the greatest odds of ED index visit admission of all age groups (adjusted odds ratio [aOR] 6.66; 95% CI 5.23–8.56), 30‐day hospitalization (aOR 7.44; 95% CI 5.63–9.99), and severe COVID‐19 (aOR 4.26; 95% CI 3.45–5.27). Compared to individuals with alternate presentations and adjusting for age, patients with typical symptoms (fever, cough and/or shortness of breath) had similar odds of ED index visit admission (aOR 1.01; 95% CI 0.81–1.24), potentially higher odds of 30‐day hospitalization (aOR 1.23; 95% CI 1.00–1.53), and greater odds of severe COVID‐19 (aOR 1.46; 95% CI 1.12–1.90). Conclusions: Older patients with COVID‐19 are more likely to have presentations without the most common symptoms. However, alternate presentations of COVID‐19 in older ED patients are not associated with greater odds of mechanical ventilation and/or death. Our data highlights the importance of a liberal COVID‐19 testing strategy among older ED patients to facilitate accurate diagnoses and timely treatment and prophylaxis.
- Subjects
UNITED States; EVALUATION of medical care; RESEARCH; REPORTING of diseases; LENGTH of stay in hospitals; COVID-19; HOSPITAL emergency services; CONFIDENCE intervals; AGE distribution; MULTIPLE regression analysis; PATIENTS; RETROSPECTIVE studies; ACQUISITION of data; HOSPITAL admission &; discharge; SEVERITY of illness index; EMERGENCY medical services; DISEASE prevalence; MEDICAL records; COUGH; PSYCHOSOCIAL factors; HOSPITAL care; DESCRIPTIVE statistics; COVID-19 testing; MEDICAL appointments; ODDS ratio; LONGITUDINAL method; MENTAL illness; OLD age
- Publication
Journal of the American Geriatrics Society, 2022, Vol 70, Issue 7, p1918
- ISSN
0002-8614
- Publication type
Article
- DOI
10.1111/jgs.17816