Clinical Profile and Outcome of Adult COVID-19- related Consults at the University of the Philippines - Philippine General Hospital Emergency Department
Background. Scarcity of early local clinical data of COVID-19 proved to be a major challenge as its course rapidly evolved over time. The information gathered from this study can be used in improving awareness and understanding a novel disease particularly in detecting demographic trends, vulnerable clinical profiles and potential clusters in order to be abreast on how the virus behaves in the local setting.
Objectives. 1) To describe the clinical profile of COVID-19 adult consults at the University of the Philippines- Philippine General Hospital (UP-PGH) during the early months of the outbreak 2) To determine their association with the COVID-19 results and final outcome
Methods. A retrospective medical record review was done on COVID-19-related consults of patients aged 19 years and above from 01 January to 30 June 2020 at the emergency department (ED). Statistical analyses were done using Chi-squared and Fisher’s exact test using STATA V15.1 with 95% level of significance (p<0.05).
Results. The median age of the 901 COVID-19-related consults at the ED was 46 years; 55.49% were males mostly belonging to the age group below 60 years. Almost all were Filipinos (99.44%), majority residing in the city of Manila (64.93%) and only 2.22% had a history of travel outside the country. The most common chief complaint was fever (32.47%) followed by cough (27.58%) and shortness of breath (25.75%). Most had their onset of symptoms from 1-7 days (79.80%) before ED arrival and 86.07% (n=210) were COVID-positive after performing the confirmatory test. Patients with confirmed COVID-19 mostly resided in cities of the National Capital Region (p=0.046), either presented with fever or asymptomatic but with exposure to COVID patients (Fisher’s Exact test; p<0.001) and onset of symptoms was 4-5 days (p=0.007). Those identified with poor prognosis were those aged 60 years and older (p<0.001), with complaint of shortness of breath (Fisher’s exact test; p<0.001) and with delayed symptom presentation of 6 days or more (p=0.037).
Conclusion. The COVID-19-related consults at UP-PGH during the first 6 months of the pandemic were mostly males, Filipinos, belonging to the less than 60 years age group (median age=46 years), residing in the city of Manila and no history of travel outside the country. The most common presenting complaint was fever and onset of symptoms was typically 1-7 days before ED arrival. The positive RT-PCR result was significantly associated to patients residing in Metro Manila, either presenting with fever or no symptoms but with exposure to COVID patients, and with onset of symptoms of 4-5 days. Older age (60 years old and above), shortness of breath and delayed symptom presentation of 6 days of more were also found to have significant association with poor prognosis. As not much is known of the behavior and course of COVID-19 particularly at the local setting, it is therefore crucial to be aware of emerging trends to respond adequately and achieve optimal outcomes.