COVID-19 SIGN Guideline: factors indicating progression to severe disease

Janet Bouttell, Olivia Wu, Kate O’Donnell and colleagues from HEHTA and General Practice and Primary Care have worked with the Scottish Inter-collegiate Guidelines Network (SIGN) to co-develop guidance on COVID-19 for primary care practitioners.

From a suggestion made to Professor Kate O’Donnell by GP colleagues working in the front line of COVID-19 assessment hubs to the publication of the results of a rapid review took just 14 days. A team effort between the Institute of Health and Wellbeing (HEHTA and GPPC) and SIGN, this guidance updates primary care practitioners about the signs, symptoms and risk factors associated with severe disease in COVID-19. Evidence came mainly from unpublished papers and researchers had to work quickly to keep up as up to 100 new papers a day are being added to preprint site MedRxiv. Although the evidence base was too weak and emergent to make definitive recommendations there were some key findings. Shortness of breath was the only symptom which was associated with severe disease. Characteristics associated with severe disease were older age, male sex and Asian ethnicity. Comorbidities/risk factors most associated with severe disease were hypertension, cardiovascular disease, diabetes, obesity, stroke, chronic pulmonary disease, chronic kidney disease and cancer. Clinical signs associated with severe disease were low oxygen saturation levels, low blood pressure and high respiratory rate.

The evidence review can be accessed here: Assessment of COVID-19 in primary care


First published: 14 March 2018

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