Discharge in Pandemic: Suspected Covid-19 patients returning to the Emergency Department within 72 hours for admission - 13/07/21
, Samuel E. Sondheim a, Nathan M. Peck a, Bess Storch a, Ka Ming Ngai a, Hsi-En Ho b, Trent She a
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Abstract |
Introduction |
Coronavirus disease 2019 (Covid-19) has led to unprecedented healthcare demand. This study seeks to characterize Emergency Department (ED) discharges suspected of Covid-19 that are admitted within 72 h.
Methods |
We abstracted all adult discharges with suspected Covid-19 from five New York City EDs between March 2nd and April 15th. Those admitted within 72 h were then compared against those who were not using descriptive and regression analysis of background and clinical characteristics.
Results |
Discharged ED patients returning within 72 h were more often admitted if suspected of Covid-19 (32.9% vs 12.1%, p < .0001). Of 7433 suspected Covid-19 discharges, the 139 (1.9%) admitted within 72 h were older (55.4 vs. 45.6 years, OR 1.03) and more often male (1.32) or with a history of obstructive lung disease (2.77) or diabetes (1.58) than those who were not admitted (p < .05). Additional associations included non-English preference, cancer, heart failure, hypertension, renal disease, ambulance arrival, higher triage acuity, longer ED stay or time from symptom onset, fever, tachycardia, dyspnea, gastrointestinal symptoms, x-ray abnormalities, and decreased platelets and lymphocytes (p < .05 for all). On 72-h return, 91 (65.5%) subjects required oxygen, and 7 (5.0%) required mechanical ventilation in the ED. Twenty-two (15.8%) of the study group have since died.
Conclusion |
Several factors emerge as associated with 72-h ED return admission in subjects suspected of Covid-19. These should be considered when assessing discharge risk in clinical practice.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Covid-19 has challenged Emergency Departments (EDs) in New York City to discharge without definitive diagnosis. |
• | Discharged ED patients returning within 72 h were more often admitted if suspected of Covid-19. |
• | Older males with lung disease or diabetes were more likely to be admitted within 72 hours of discharge. |
• | Gastrointestinal symptoms and decreased platelets and lymphocytes were associated with 72-hour return admission. |
• | The study group suffered significant morbidity and mortality, with most requiring oxygen supplementation. |
Keywords : Coronavirus, Patient discharge, Emergency medicine, Clinical decision-making, Pandemics, Disaster medicine
Plan
Vol 45
P. 185-191 - juillet 2021 Retour au numéro
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