COVID-19: Symptoms, course of illness and use of clinical scoring systems for the first 42 patients admitted to a Norwegian local hospital

• Published in: Tidsskrift for den Norske Lægeforening Vol. 140; no. 7
• Main Authors: Ihle-Hansen, Håkon, Berge, Trygve, Tveita, Anders, Rønning, Else Johanne, Ernø, Per Erik, Andersen, Elizabeth Lyster, Wang, Christian Hjorth, Tveit, Arnljot, Myrstad, Marius
• Format: Journal Article
• Language: English; Norwegian
• Published: Norway 05-05-2020
• Subjects: Adult; Aged; Aged, 80 and over; Betacoronavirus; Clinical Laboratory Techniques; Coronavirus Infections - complications; Coronavirus Infections - diagnosis; Coronavirus Infections - epidemiology; Cough - etiology; COVID-19; COVID-19 Testing; Critical Illness; Dyspnea - etiology; Emergency Service, Hospital; Fever - etiology; Humans; Male; Middle Aged; Norway - epidemiology; Organ Dysfunction Scores; Pandemics; Pneumonia, Viral - complications; Pneumonia, Viral - diagnosis; Pneumonia, Viral - epidemiology; Retrospective Studies; SARS-CoV-2; Severity of Illness Index; Norway
• ISSN: 0807-7096
• DOI: 10.4045/tidsskr.20.0301

The COVID-19 outbreak is presenting the health system with new challenges, and there is a great need for knowledge about symptoms, clinical findings and course of illness in patients admitted to Norwegian hospitals with COVID-19.
In this observational qualitative study, all patients admitted to a Norwegian local hospital (Bærum Hospital) with proven COVID-19 infection were included consecutively from the start of the outbreak. We present here patient characteristics, symptoms, clinical findings, experience of using clinical scoring systems and course of illness based on data in medical records.
In the period 9-31 March 2020, 42 patients, of whom 28 (67 %) were men, were admitted to hospital with COVID-19 infection. The median age was 72.5 years (range 30-95). Fever (79 %), reduced general condition (79 %), dyspnoea (69 %) and cough (67 %) were the most common symptoms. A total of nine patients (21 %) had a critical course of illness with treatment in the Intensive Care Department and/or death during their stay in hospital. Patients with a critical course had a higher average score on National Early Warning Score 2 (NEWS2) on admission (7.6 vs 3.3). Only one of the most severely ill patients scored ≥ 2 on the quick Sepsis-related Organ Failure Assessment (qSOFA) on admission.
Most patients admitted to our hospital with COVID-19 had a fever and respiratory tract symptoms. A high percentage of patients had a critical course of illness. A NEWS2 score of ≥ 5 on admission may be a useful aid in identifying patients at risk of a critical course of illness, while CRB-65 and qSOFA score ≥ 2 proved to be of little usefulness for this purpose in our material.