Open AccessNeurological symptoms in Covid‐19 patients in the emergency department
Author(s) -
GarcíaAzorín David,
Trigo Javier,
MartínezPías Enrique,
HernándezPérez Isabel,
VallePeñacoba Gonzalo,
Talavera Blanca,
SimónCampo Paula,
Lera Mercedes,
ChavarríaMiranda Alba,
LópezSanz Cristina,
GutiérrezSánchez María,
MartínezVelasco Elena,
Pedraza María,
Sierra Álvaro,
GómezVicente Beatriz,
Guerrero Ángel,
Arenillas Juan Francisco
Publication year - 2021
Publication title -
brain and behavior
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.915
H-Index - 41
ISSN - 2162-3279
DOI - 10.1002/brb3.2058
Subject(s) - medicine , emergency department , anosmia , proportional hazards model , myalgia , dysgeusia , retrospective cohort study , cohort , confidence interval , pediatrics , altered mental status , disease , covid-19 , psychiatry , infectious disease (medical specialty) , adverse effect
Background Coronavirus disease 2019 (Covid‐19) might present neurological symptoms. We aimed to evaluate the frequency of them at the moment of emergency department (ED) visit and their impact in the prognosis. Methods Retrospective cohort study including all consecutive hospitalized cases between March 8th and April 11th, 2020. Covid‐19 diagnosis was confirmed by polymerase chain reaction test and/or serology. We compared, in patients with and without neurological symptoms on admission, demographic, clinical presentation, and frequency and type of abnormal laboratory values. We analyzed the variables that were associated with in‐hospital all‐cause mortality by Cox‐regression log‐rank test. Results We included 576 hospitalized patients, 250 (43.3%) female, aged 67.2 years. At the moment of ED visit, 320 (55.6%) described neurological symptoms, including anosmia (146, 25.3%), myalgia (139, 24.1%), headache (137, 23.8%), and altered mental status (98, 17.0%). Neurological symptoms started the first symptomatic day in 198 (54.2%) cases. Patients with neurological symptoms presented later to the ED (7.9 versus. 6.6 days, p = .019). Only four (0.6%) cases had no typical Covid‐19 general symptoms, and only six (1.9%) had a normal laboratory results, for a sensitivity of 98.7% (95% confidence interval (CI): 96.6%–99.6%) and 98.1% (95% CI: 95.7%–99.2%), respectively. In the multivariate Cox‐regression of mortality predictors, anosmia (HR: 0.358, 95%CI: 0.140–0.916) and altered mental status (HR: 1.867, 95%CI: 1.162–3.001) were significant. Conclusion Neurological symptoms were the most frequent extrapulmonary symptoms. They were present in half of the Covid‐19 patients at the time of the ED visit. Anosmia on admission was an independent predictor of lower in‐hospital mortality and altered mental status on admission predicted in‐hospital mortality.