密歇根州大量新冠门诊患者队列的流行病学、临床特征及转归
Epidemiology, Clinical Characteristics, and Outcomes of a Large Cohort of COVID-19 Outpatients in Michigan.
作者信息
Halalau Alexandra, Odish Fadi, Imam Zaid, Sharrak Aryana, Brickner Evan, Lee Paul Bumki, Foglesong Adam, Michel Adrian, Gill Inayat, Qu Lihua, Abbas Amr E, Carpenter Christopher F
机构信息
Internal Medicine Department, Beaumont Health, Royal Oak, MI, USA.
Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
出版信息
Int J Gen Med. 2021 Apr 28;14:1555-1563. doi: 10.2147/IJGM.S305295. eCollection 2021.
BACKGROUND
Most outpatients with coronavirus disease 2019 (COVID-19) do not initially demonstrate severe features requiring hospitalization. Understanding this population's epidemiological and clinical characteristics to allow outcome anticipation is crucial in healthcare resource allocation.
METHODS
Retrospective, multicenter (8 hospitals) study reporting on 821 patients diagnosed with COVID-19 by real-time reverse transcriptase-polymerase chain reaction assay of nasopharyngeal swabs and discharged home to self-isolate after evaluation in emergency departments (EDs) within Beaumont Health System in March, 2020. Outcomes were collected through April 14, 2020, with a minimum of 12 day follow-up and included subsequent ED visit, admission status, and mortality.
RESULTS
Of the 821 patients, mean age was 49.3 years (SD 15.7), 46.8% were male and 55.1% were African-American. Cough was the most frequent symptom in 78.2% of patients with a median duration of 3 days (IQR 2-7), and other symptoms included fever 62.1%, rhinorrhea or nasal congestion 35.1% and dyspnea 31.2%. ACEI/ARBs usage was reported in 28.7% patients and 34.0% had diabetes mellitus. Return to the ED for re-evaluation was reported in 19.2% of patients from whom 54.4% were admitted. The patients eventually admitted to the hospital were older (mean age 54.4 vs 48.7 years, =0.002), had higher BMI (35.4 kg/m vs 31.9 kg/m, =0.004), were more likely male (58.1% vs 45.4%, =0.026), and more likely to have hypertension (52.3% vs 29.4%, <0.001), diabetes mellitus (74.4% vs 29.3%, <0.001) or prediabetes (25.6% vs 8.4%, <0.001), COPD (39.5% vs 5.4%, <0.001), and OSA (36% vs 19%, <0.001). The overall mortality rate was 1.3%.
CONCLUSION
We found that 80.8% of patients did not return to the ED for re-evaluation. Sending patients with COVID-19 home if they experience mild symptoms is a safe approach for most patients and might mitigate some of the financial and staffing pressures on healthcare systems.
背景
大多数2019冠状病毒病（COVID-19）门诊患者最初并无需要住院治疗的严重症状。了解这一人群的流行病学和临床特征以预测病情转归，对于医疗资源分配至关重要。
方法
一项回顾性多中心（8家医院）研究，报告了2020年3月在博蒙特医疗系统急诊科经评估后，通过鼻咽拭子实时逆转录聚合酶链反应检测确诊为COVID-19且出院回家自我隔离的821例患者。至2020年4月14日收集结局数据，随访至少12天，结局包括随后的急诊科复诊、入院情况及死亡率。
结果
821例患者中，平均年龄为49.3岁（标准差15.7），46.8%为男性，55.1%为非裔美国人。咳嗽是最常见症状，78.2%的患者出现咳嗽，中位持续时间为3天（四分位间距2 - 7天），其他症状包括发热62.1%、流涕或鼻塞35.1%以及呼吸困难31.2%。28.7%的患者报告使用过血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体阻滞剂，34.0%的患者患有糖尿病。19.2%的患者返回急诊科进行重新评估，其中54.4%入院。最终入院的患者年龄更大（平均年龄54.4岁对48.7岁，P = 0.002），体重指数更高（35.4kg/m²对31.9kg/m²，P = 0.004），男性比例更高（58.1%对45.4%，P = 0.026），更可能患有高血压（52.3%对29.4%，P < 0.001）、糖尿病（74.4%对29.3%，P < 0.001）或糖尿病前期（25.6%对8.4%，P < 0.001）、慢性阻塞性肺疾病（39.5%对5.4%，P < 0.001）和阻塞性睡眠呼吸暂停（36%对19%，P < 0.001）。总死亡率为1.3%。
结论
我们发现80.8%的患者未返回急诊科进行重新评估。对于大多数症状轻微的COVID-19患者，让其回家是一种安全的做法，可能会减轻医疗系统的一些财务和人员压力。
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