Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Emerg Med J. 2021 Apr;38(4):304-307. doi: 10.1136/emermed-2020-210041. Epub 2021 Feb 18.
EDs are often the first line of contact with individuals infected with COVID-19 and play a key role in triage. However, there is currently little specific guidance for deciding when patients with COVID-19 require hospitalisation and when they may be safely observed as an outpatient.
In this retrospective study, we characterised all patients with COVID-19 discharged home from EDs in our US multisite healthcare system from March 2020 to August 2020, focusing on individuals who returned within 2 weeks and required hospital admission. We restricted analyses to first-encounter data that do not depend on laboratory or imaging diagnostics in order to inform point-of-care assessments in resource-limited environments. Vitals and comorbidities were extracted from the electronic health record. We performed ordinal logistic regression analyses to identify predictors of inpatient admission, intensive care and intubation.
Of n=923 patients who were COVID-19 positive discharged from the ED, n=107 (11.6%) returned within 2 weeks and were admitted. In a multivariable-adjusted model including n=788 patients with complete risk factor information, history of hypertension increased odds of hospitalisation and severe illness by 1.92-fold (95% CI 1.07 to 3.41), diabetes by 2.20-fold (1.18 to 4.02), chronic lung disease by 2.21-fold (1.22 to 3.92) and fever by 2.89-fold (1.71 to 4.82). Having at least two of these risk factors increased the odds of future hospitalisation by 6.68-fold (3.54 to 12.70). Patients with hypertension, diabetes, chronic lung disease or fever had significantly longer hospital stays (median 5.92 days, 3.08-10.95 vs 3.21, 1.10-5.75, p<0.01) with numerically higher but not significantly different rates of intensive care unit admission (27.02% vs 14.30%, p=0.27) and intubation (12.16% vs 7.14%, p=0.71).
Patients infected with COVID-19 may appear clinically safe for home convalescence. However, those with hypertension, diabetes, chronic lung disease and fever may in fact be only 'pseudo-safe' and are most at risk for subsequent hospitalisation with more severe illness and longer hospital stays.
急诊科通常是与感染 COVID-19 的个体接触的第一线，在分诊中起着关键作用。然而，目前针对需要住院治疗的 COVID-19 患者以及可以安全作为门诊观察的患者，几乎没有具体的指导。
在这项回顾性研究中，我们对我们美国多地点医疗保健系统中从 2020 年 3 月至 2020 年 8 月从急诊科出院的所有 COVID-19 阳性患者进行了特征描述，重点关注在两周内返回并需要住院治疗的患者。我们将分析仅限于首次就诊数据，这些数据不依赖于实验室或影像学诊断，以便为资源有限的环境中的护理点评估提供信息。生命体征和合并症从电子健康记录中提取。我们进行了有序逻辑回归分析，以确定住院、重症监护和插管的预测因素。
在从急诊科出院的 923 名 COVID-19 阳性患者中，有 107 名（11.6%）在两周内返回并住院。在包括 788 名具有完整危险因素信息的患者的多变量调整模型中，高血压史使住院和严重疾病的几率增加了 1.92 倍（95%CI 1.07 至 3.41），糖尿病增加了 2.20 倍（1.18 至 4.02），慢性肺部疾病增加了 2.21 倍（1.22 至 3.92），发热增加了 2.89 倍（1.71 至 4.82）。至少有两个这些危险因素会使未来住院的几率增加 6.68 倍（3.54 至 12.70）。患有高血压、糖尿病、慢性肺部疾病或发热的患者住院时间明显更长（中位数 5.92 天，3.08-10.95 与 3.21，1.10-5.75，p<0.01），入住重症监护病房的比例虽高但无统计学差异（27.02% 与 14.30%，p=0.27）和插管（12.16% 与 7.14%，p=0.71）。
感染 COVID-19 的患者可能在临床康复方面表现为安全。然而，那些患有高血压、糖尿病、慢性肺部疾病和发热的患者实际上可能只是“假性安全”，他们最有可能因随后出现更严重的疾病和更长的住院时间而再次住院。
