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Improving the early identification of COVID-19 pneumonia: a narrative review

Delayed presentation of COVID-19 pneumonia increases the risk of mortality and need for high-intensity healthcare. Conversely, early identification of COVID-19 pneumonia grants an opportunity to intervene early and thus prevent more complicated, protracted and less successful hospital admissions. To...

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Autores principales: Goyal, Daniel, Inada-Kim, Matthew, Mansab, Fatam, Iqbal, Amir, McKinstry, Brian, Naasan, Adeeb P, Millar, Colin, Thomas, Stephen, Bhatti, Sohail, Lasserson, Daniel, Burke, Derek
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8573292/
https://www.ncbi.nlm.nih.gov/pubmed/34740942
http://dx.doi.org/10.1136/bmjresp-2021-000911
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author Goyal, Daniel
Inada-Kim, Matthew
Mansab, Fatam
Iqbal, Amir
McKinstry, Brian
Naasan, Adeeb P
Millar, Colin
Thomas, Stephen
Bhatti, Sohail
Lasserson, Daniel
Burke, Derek
author_facet Goyal, Daniel
Inada-Kim, Matthew
Mansab, Fatam
Iqbal, Amir
McKinstry, Brian
Naasan, Adeeb P
Millar, Colin
Thomas, Stephen
Bhatti, Sohail
Lasserson, Daniel
Burke, Derek
author_sort Goyal, Daniel
collection PubMed
description Delayed presentation of COVID-19 pneumonia increases the risk of mortality and need for high-intensity healthcare. Conversely, early identification of COVID-19 pneumonia grants an opportunity to intervene early and thus prevent more complicated, protracted and less successful hospital admissions. To improve the earlier detection of COVID-19 pneumonia in the community we provide a narrative review of current evidence examining the clinical parameters associated with early disease progression. Through an evolving literature review, we examined: the symptoms that may suggest COVID-19 progression; the timing of deterioration; the utility of basic observations, clinical examination and chest X-ray; the value of postexertion oxygen saturations; and the use of CRP to monitor disease progression. We go on to discuss the challenges in monitoring the COVID-19 patient in the community and discuss thresholds for further assessment. Confusion, persistent fever and shortness of breath were identified as worrying symptoms suggestive of COVID-19 disease progression necessitating urgent clinical contact. Importantly, a significant proportion of COVID-19 pneumonia patients appear not to suffer dyspnoea despite severe disease. Patients with this asymptomatic hypoxia seem to have a poorer prognosis. Such patients may present with other signs of hypoxia: severe fatigue, exertional fatigue and/or altered mental status. We found duration of symptoms to be largely unhelpful in determining risk, with evidence of deterioration at any point in the disease. Basic clinical parameters (pulse, respiratory rate, blood pressure, temperature and oxygen saturations (SpO(2))) are likely of high value in detecting the deteriorating community COVID-19 patient and/or COVID-19 mimickers/complications (eg, sepsis, bacterial pneumonia and pulmonary embolism). Of these, SpO(2) carried the greatest utility in detecting COVID-19 progression. CRP is an early biochemical parameter predictive of disease progression and used appropriately is likely to contribute to the early identification of COVID-19 pneumonia. Identifying progressive COVID-19 in the community is feasible using basic clinical questions and measurements. As such, if we are to limit the mortality, morbidity and the need for complicated, protracted admissions, monitoring community COVID-19 cases for signs of deterioration to facilitate early intervention is a viable strategy.
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spelling pubmed-85732922021-11-08 Improving the early identification of COVID-19 pneumonia: a narrative review Goyal, Daniel Inada-Kim, Matthew Mansab, Fatam Iqbal, Amir McKinstry, Brian Naasan, Adeeb P Millar, Colin Thomas, Stephen Bhatti, Sohail Lasserson, Daniel Burke, Derek BMJ Open Respir Res Respiratory Infection Delayed presentation of COVID-19 pneumonia increases the risk of mortality and need for high-intensity healthcare. Conversely, early identification of COVID-19 pneumonia grants an opportunity to intervene early and thus prevent more complicated, protracted and less successful hospital admissions. To improve the earlier detection of COVID-19 pneumonia in the community we provide a narrative review of current evidence examining the clinical parameters associated with early disease progression. Through an evolving literature review, we examined: the symptoms that may suggest COVID-19 progression; the timing of deterioration; the utility of basic observations, clinical examination and chest X-ray; the value of postexertion oxygen saturations; and the use of CRP to monitor disease progression. We go on to discuss the challenges in monitoring the COVID-19 patient in the community and discuss thresholds for further assessment. Confusion, persistent fever and shortness of breath were identified as worrying symptoms suggestive of COVID-19 disease progression necessitating urgent clinical contact. Importantly, a significant proportion of COVID-19 pneumonia patients appear not to suffer dyspnoea despite severe disease. Patients with this asymptomatic hypoxia seem to have a poorer prognosis. Such patients may present with other signs of hypoxia: severe fatigue, exertional fatigue and/or altered mental status. We found duration of symptoms to be largely unhelpful in determining risk, with evidence of deterioration at any point in the disease. Basic clinical parameters (pulse, respiratory rate, blood pressure, temperature and oxygen saturations (SpO(2))) are likely of high value in detecting the deteriorating community COVID-19 patient and/or COVID-19 mimickers/complications (eg, sepsis, bacterial pneumonia and pulmonary embolism). Of these, SpO(2) carried the greatest utility in detecting COVID-19 progression. CRP is an early biochemical parameter predictive of disease progression and used appropriately is likely to contribute to the early identification of COVID-19 pneumonia. Identifying progressive COVID-19 in the community is feasible using basic clinical questions and measurements. As such, if we are to limit the mortality, morbidity and the need for complicated, protracted admissions, monitoring community COVID-19 cases for signs of deterioration to facilitate early intervention is a viable strategy. BMJ Publishing Group 2021-11-05 /pmc/articles/PMC8573292/ /pubmed/34740942 http://dx.doi.org/10.1136/bmjresp-2021-000911 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Respiratory Infection
Goyal, Daniel
Inada-Kim, Matthew
Mansab, Fatam
Iqbal, Amir
McKinstry, Brian
Naasan, Adeeb P
Millar, Colin
Thomas, Stephen
Bhatti, Sohail
Lasserson, Daniel
Burke, Derek
Improving the early identification of COVID-19 pneumonia: a narrative review
title Improving the early identification of COVID-19 pneumonia: a narrative review
title_full Improving the early identification of COVID-19 pneumonia: a narrative review
title_fullStr Improving the early identification of COVID-19 pneumonia: a narrative review
title_full_unstemmed Improving the early identification of COVID-19 pneumonia: a narrative review
title_short Improving the early identification of COVID-19 pneumonia: a narrative review
title_sort improving the early identification of covid-19 pneumonia: a narrative review
topic Respiratory Infection
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8573292/
https://www.ncbi.nlm.nih.gov/pubmed/34740942
http://dx.doi.org/10.1136/bmjresp-2021-000911
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