COVID-19 患者返回急诊科的特征和结局：加拿大 COVID-19 急诊科快速反应网络（CCEDRRN）的一项多中心观察性研究。

Characteristics and outcomes of patients with COVID-19 who return to the emergency department: a multicentre observational study by the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN).

机构信息

Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada

Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.

出版信息

Emerg Med J. 2024 Mar 21;41(4):210-217. doi: 10.1136/emermed-2023-213277.

DOI:10.1136/emermed-2023-213277

PMID:38365437

Abstract

OBJECTIVE

Unplanned return emergency department (ED) visits can reflect clinical deterioration or unmet need from the original visit. We determined the characteristics and outcomes of patients with COVID-19 who return to the ED for COVID-19-related revisits.

METHODS

This retrospective observational study used data for all adult patients visiting 47 Canadian EDs with COVID-19 between 1 March 2020 and 31 March 2022. Multivariable logistic regression assessed the characteristics associated with having a no return visit (SV=single visit group) versus at least one return visit (MV=return visit group) after being discharged alive at the first ED visit.

RESULTS

39 809 patients with COVID-19 had 44 862 COVID-19-related ED visits: 35 468 patients (89%) had one visit (SV group) and 4341 (11%) returned to the ED (MV group) within 30 days (mean 2.2, SD=0.5 ED visit). 40% of SV patients and 16% of MV patients were admitted at their first visit, and 41% of MV patients not admitted at their first ED visit were admitted on their second visit. In the MV group, the median time to return was 4 days, 49% returned within 72 hours. In multivariable modelling, a repeat visit was associated with a variety of factors including older age (OR=1.25 per 10 years, 95% CI (1.22 to 1.28)), pregnancy (1.86 (1.46 to 2.36)) and presence of comorbidities (eg, 1.72 (1.40 to 2.10) for cancer, 2.01 (1.52 to 2.66) for obesity, 2.18 (1.42 to 3.36) for organ transplant), current/prior substance use, higher temperature or WHO severe disease (1.41 (1.29 to 1.54)). Return was less likely for females (0.82 (0.77 to 0.88)) and those boosted or fully vaccinated (0.48 (0.34 to 0.70)).

CONCLUSIONS

Return ED visits by patients with COVID-19 within 30 days were common during the first two pandemic years and were associated with multiple factors, many of which reflect known risk for worse outcomes. Future studies should assess reasons for revisit and opportunities to improve ED care and reduce resource use.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov, NCT04702945.

摘要

目的

非计划返回急诊部（ED）就诊可反映出患者在初次就诊后出现临床恶化或未满足需求的情况。本研究旨在明确 COVID-19 患者返回 ED 进行 COVID-19 相关复诊的特征和结局。

方法

本回顾性观察性研究使用了 2020 年 3 月 1 日至 2022 年 3 月 31 日期间在加拿大 47 家 ED 就诊的所有成年 COVID-19 患者的数据。多变量逻辑回归评估了与初次 ED 就诊时存活出院后无返回就诊（单就诊组 SV=single visit group）与至少有一次返回就诊（多就诊组 MV=return visit group）相关的特征。

结果

39809 例 COVID-19 患者进行了 44862 次 COVID-19 相关 ED 就诊：35468 例（89%）就诊一次（SV 组），4341 例（11%）在 30 天内（平均 2.2 天，SD=0.5 就诊）返回 ED（MV 组）。40%的 SV 患者和 16%的 MV 患者初次就诊时被收治入院，41%的 MV 患者初次就诊时未收治入院，在第二次就诊时被收治入院。MV 组中，中位复诊时间为 4 天，49%的患者在 72 小时内复诊。多变量模型显示，多种因素与复诊相关，包括年龄增长（每增加 10 岁，OR=1.25，95%CI 1.22 至 1.28）、妊娠（1.86（1.46 至 2.36））和合并症（如癌症 1.72（1.40 至 2.10），肥胖症 2.01（1.52 至 2.66），器官移植 2.18（1.42 至 3.36））、当前/既往药物滥用、更高的体温或世卫组织严重疾病（1.41（1.29 至 1.54））。女性（0.82（0.77 至 0.88））和已接种或已完全接种疫苗的患者（0.48（0.34 至 0.70））复诊的可能性较低。