Predicting 30 – Day outcomes in emergency department patients discharged with COVID-19

Determining disposition for COVID-19 patients can be difficult for emergency medicine clinicians. Previous studies have demonstrated risk factors which predict severe infection and mortality however little is known about which risk factors are associated with failure of outpatient management and sub...

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Bibliographic Details
Published in:The American journal of emergency medicine 2021-12, Vol.50, p.513-517
Main Authors: McKay, Benjamin, Meyers, Matthew, Rivard, Leah, Stoltzfus, Jill, Rammohan, Guhan, Stankewicz, Holly
Format: Article
Language:English
Subjects:
Adult
Age
Age Factors
Aged
Aged, 80 and over
Comorbidity
Coronary artery
Coronaviruses
COVID-19
COVID-19 - diagnosis
COVID-19 - mortality
COVID-19 - therapy
Demographics
Diabetes mellitus
Emergency medical care
Emergency medical services
Emergency Service, Hospital
Female
Heart diseases
Hospital systems
Hospitals
Humans
Hypertension
Hypoxia
Kidney diseases
Male
Malignancy
Middle Aged
Outcome Assessment, Health Care
Oxygen saturation
Pandemics
Patient Discharge
Patient Readmission
Patients
Predictive Value of Tests
Retrospective Studies
Risk Factors
Severe acute respiratory syndrome coronavirus 2
Variables
Vital signs
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Summary:Determining disposition for COVID-19 patients can be difficult for emergency medicine clinicians. Previous studies have demonstrated risk factors which predict severe infection and mortality however little is known about which risk factors are associated with failure of outpatient management and subsequent admission for COVID-19 patients. We conducted a retrospective observational chart review of patients who had a confirmed positive COVID-19 test collected during an ED visit between March 1, 2020 and October 11, 2020. Patients were divided into two groups based on presence or absence of a subsequent 30-day hospitalization. Clinical and demographic information were collected including chief complaint, triage vital signs and comorbid medical conditions. 1038 patients were seen and discharged from a network ED with a positive SARS-CoV-2 PCR test. 94 patients (9.1%) were admitted to a hospital within 30 days of the index ED visit while 944 (90.9%) were not admitted to a network hospital within 30 days. Patients that were admitted were more likely to be older (aOR = 1.04 (95% CI 1.03–1.06)), hypoxic (aOR = 2.16 (95% CI 1.14–4.10)) and tachycardic (aOR = 2.13 (95% CI 1.34–3.38)) on initial ED presentation. Preexisting hypertension, diabetes mellitus, coronary artery disease, chronic kidney disease and malignancy were all highly significant risk factors for 30-day hospital admission following initial ED discharge (p 
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2021.08.077