From the Guidelines
The patient's history of present illness (HPI) should include a detailed account of his persistent symptoms following COVID-19 and influenza infections, as well as his recent improvement and upcoming surgery. The 56-year-old male patient presents today for follow-up of persistent symptoms following COVID-19 and influenza infections. He reports significant improvement in his condition since the last visit. A chest X-ray ordered at the previous appointment showed normal results. The patient states he has received communication from ENT regarding a recent CT scan and has been scheduled for upcoming surgery, though specific details about the nature of the surgery were not provided. He denies any new or concerning symptoms at this time. The patient mentions he has an upcoming appointment with his specialist for continued management.
Key Points to Consider
- The patient's symptoms and recent improvement should be carefully documented, as they may impact his upcoming surgery 1.
- The patient's recent CT scan and upcoming surgery should be noted, as they may be relevant to his current condition and treatment plan 1.
- The patient's denial of new or concerning symptoms is important, as it suggests that his condition is stable at this time 1.
- The patient's upcoming appointment with his specialist is a crucial aspect of his ongoing management and should be noted in his HPI.
Relevant Guidelines and Evidence
- The Association of Anaesthetists, the Centre for Peri-operative Care, the Federation of Surgical Specialty Associations, the Royal College of Anaesthetists, and the Royal College of Surgeons of England recommend that elective surgery should not be scheduled within 7 weeks of a diagnosis of SARS-CoV-2 infection unless the risks of deferring surgery outweigh the risk of postoperative morbidity or mortality associated with COVID-19 1.
- The guidelines also suggest that patients with persistent symptoms of COVID-19 are at increased risk of postoperative morbidity and mortality even after 7 weeks, and that the time before surgery should be used for functional assessment, prehabilitation, and multidisciplinary optimisation 1.
From the Research
History of Present Illness (HPI)
The patient is a 56-year-old individual who presents with a history of persistent symptoms following COVID-19 and influenza infections.
- The patient had previously undergone a chest X-ray, which showed normal results 2, 3.
- Despite the normal chest X-ray findings, the patient's symptoms persisted, leading to further investigation, including a CT scan 4, 5, 6.
- The patient has recently received the results of the CT scan from the ENT specialist and is scheduled for upcoming surgery.
- The patient reports feeling much better at the time of the current assessment and denies any other concerns.
- The patient has an upcoming appointment with their specialist to further discuss their condition and treatment plan.
Relevant Studies
- A study comparing the degree of chest CT scan abnormalities in COVID-19 and influenza patients found similar severity levels of lung abnormalities in both groups 3.
- Another study comparing chest X-ray findings in COVID-19 and influenza patients found similar severity levels of features on chest X-rays, with most patients demonstrating normal to mildly abnormal findings 2.
- A narrative review of chest CT findings in COVID-19 and influenza found overlapping features, with some differences in the distribution of ground-glass opacities and the presence of vascular engorgement and pleural thickening in COVID-19 patients 4.
- A multireader study comparing chest CT findings of COVID-19, influenza, and organizing pneumonia found significant overlap between the three conditions, with low diagnostic accuracy for radiologists 5.
- A study comparing clinical and chest CT findings in patients with influenza A (H1N1) virus infection and COVID-19 found differences in the presence of linear opacification, crazy-paving sign, and vascular enlargement in COVID-19 patients 6.