School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom.
Intensive Care, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom.
PLoS One. 2020 Nov 25;15(11):e0240206. doi: 10.1371/journal.pone.0240206. eCollection 2020.
Hospital emergency departments play a crucial role in the initial assessment and management of suspected COVID-19 infection. This needs to be guided by studies of people presenting with suspected COVID-19, including those admitted and discharged, and those who do not ultimately have COVID-19 confirmed. We aimed to characterise patients attending emergency departments with suspected COVID-19, including subgroups based on sex, ethnicity and COVID-19 test results.
We undertook a mixed prospective and retrospective observational cohort study in 70 emergency departments across the United Kingdom (UK). We collected presenting data from 22445 people attending with suspected COVID-19 between 26 March 2020 and 28 May 2020. Outcomes were admission to hospital, COVID-19 result, organ support (respiratory, cardiovascular or renal), and death, by record review at 30 days. Mean age was 58.4 years, 11200 (50.4%) were female and 11034 (49.6%) male. Adults (age >16 years) were acutely unwell (median NEWS2 score of 4), frequently had limited performance status (46.9%) and had high rates of admission (67.1%), COVID-19 positivity (31.2%), organ support (9.8%) and death (15.5%). Children had much lower rates of admission (27.4%), COVID-19 positivity (1.2%), organ support (1.4%) and death (0.3%). Similar numbers of men and women presented to the ED, but men were more likely to be admitted (72.9% v 61.4%), require organ support (12.2% v 7.7%) and die (18.2% v 13.0%). Black or Asian adults tended to be younger than White adults (median age 54, 50 and 67 years), were less likely to have impaired performance status (43.1%, 26.8% and 51.6%), be admitted to hospital (60.8%, 57.3%, 69.6%) or die (11.6%, 11.2%, 16.4%), but were more likely to require organ support (15.9%, 14.3%, 8.9%) or have a positive COVID-19 test (40.8%, 42.1%, 30.0%). Adults admitted with suspected and confirmed COVID-19 had similar age, performance status and comorbidities (except chronic lung disease) to those who did not have COVID-19 confirmed, but were much more likely to need organ support (22.2% v 8.9%) or die (32.1% v 15.5%).
Important differences exist between patient groups presenting to the emergency department with suspected COVID-19. Adults and children differ markedly and require different approaches to emergency triage. Admission and adverse outcome rates among adults suggest that policies to avoid unnecessary ED attendance achieved their aim. Subsequent COVID-19 confirmation confers a worse prognosis and greater need for organ support.
ISRCTN registry, ISRCTN56149622, http://www.isrctn.com/ISRCTN28342533.
医院急诊科在对疑似 COVID-19 感染进行初步评估和管理方面发挥着至关重要的作用。这需要以对出现疑似 COVID-19 的患者进行的研究为指导，包括已入院和已出院的患者，以及最终未确诊 COVID-19 的患者。我们旨在描述在急诊科就诊的疑似 COVID-19 患者，包括基于性别、种族和 COVID-19 检测结果的亚组。
我们在英国（UK）的 70 个急诊科进行了一项混合前瞻性和回顾性观察队列研究。我们从 2020 年 3 月 26 日至 5 月 28 日期间收集了 22445 名疑似 COVID-19 患者的就诊数据。通过 30 天的记录回顾，评估了住院、COVID-19 检测结果、器官支持（呼吸、心血管或肾脏）和死亡等结局。平均年龄为 58.4 岁，11200 名（50.4%）为女性，11034 名（49.6%）为男性。成年人（年龄>16 岁）病情急性恶化（中位 NEWS2 评分 4），表现状态受限的情况较为常见（46.9%），住院率（67.1%）、COVID-19 阳性率（31.2%）、器官支持率（9.8%）和死亡率（15.5%）均较高。儿童的住院率（27.4%）、COVID-19 阳性率（1.2%）、器官支持率（1.4%）和死亡率（0.3%）均较低。男性和女性就诊人数相近，但男性更有可能住院（72.9%比 61.4%）、需要器官支持（12.2%比 7.7%）和死亡（18.2%比 13.0%）。黑人或亚洲成年人往往比白人成年人年轻（中位数年龄分别为 54、50 和 67 岁），表现状态受限的情况较少（43.1%、26.8%和 51.6%）、住院率（60.8%、57.3%和 69.6%）和死亡率（11.6%、11.2%和 16.4%）较低，但需要器官支持的可能性（15.9%、14.3%和 8.9%）或 COVID-19 检测阳性的可能性（40.8%、42.1%和 30.0%）较高。因疑似和确诊 COVID-19 而住院的成年人与未确诊 COVID-19 的成年人在年龄、表现状态和合并症（除慢性肺病外）方面相似，但更有可能需要器官支持（22.2%比 8.9%）或死亡（32.1%比 15.5%）。
急诊科就诊的疑似 COVID-19 患者群体存在重要差异。成年人和儿童差异显著，需要采用不同的紧急分诊方法。成年人的入院率和不良预后率表明，避免不必要的急诊科就诊的政策达到了预期目标。随后的 COVID-19 确诊预示着预后更差，需要更多的器官支持。
ISRCTN 注册处，ISRCTN56149622，http://www.isrctn.com/ISRCTN28342533。
