Is the Presence of a Typical Triad of COVID-19 Symptoms (Cough, Dyspnea, and Fever) Enough to Make a Decision About Diagnostic Testing? From the Perspective of an Emergency Department

Objective: The aim of this study is to show the consistence between the recommended guidelines regarding the triad of symptoms—cough, dyspnea, and fever—and the diagnosis of COVID-19. Methods: A prospective observational study conducted at a tertiary emergency department between April 2, 2020 and May 15, 2020 in Turkey. Detailed patient history, main presenting complaints and imaging findings were recorded. For COVID-19 confirmation, nasopharyngeal RT-PCR was used. The relationship between complaints and COVID-19 test results were analyzed. Results: Of the 1226, suspected COVID-19 patients, 127 were positive, 471 were negative, and 628 were discharged without any tests. The most common presenting complaints of the COVID-19 positive patients were throat pain (25.2%), dyspnea (15%), cough (22%), malaise and fatigue (11.8%), and fever (8.7%). There was no statistically significant difference between the positive and negative test groups as they had fever (χ2, p = 0.30), cough (χ2, p = 0.67) and dyspnea (χ2, p = 0.14). Conclusion: Considering that it is difficult to diagnose COVID-19 in emergency settings, testing decision and diagnosis should not depend only on classical symptoms; otherwise, patients with atypical and rare symptoms may be missed. Instead, patient history, clinical status, and radiological findings should be considered together.