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10.1136/emermed-2020-210041

http://scihub22266oqcxt.onion/10.1136/emermed-2020-210041
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33602725!8371069!33602725
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suck abstract from ncbi


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pmid33602725      Emerg+Med+J 2021 ; 38 (4): 304-307
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  • Pseudo-safety in a cohort of patients with COVID-19 discharged home from the emergency department #MMPMID33602725
  • Yuan N; Ji H; Sun N; Botting P; Nguyen T; Torbati S; Cheng S; Ebinger J
  • Emerg Med J 2021[Apr]; 38 (4): 304-307 PMID33602725show ga
  • INTRODUCTION: 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. METHODS: 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. RESULTS: 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). DISCUSSION: 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.
  • |*Emergency Service, Hospital/statistics & numerical data[MESH]
  • |*Patient Discharge/statistics & numerical data[MESH]
  • |Age Factors[MESH]
  • |Ambulatory Care/methods/statistics & numerical data[MESH]
  • |COVID-19/diagnosis/*therapy[MESH]
  • |Critical Care/statistics & numerical data[MESH]
  • |Humans[MESH]
  • |Logistic Models[MESH]
  • |Male[MESH]
  • |Patient Admission/statistics & numerical data[MESH]
  • |Patient Safety[MESH]
  • |Respiration, Artificial/statistics & numerical data[MESH]
  • |Retrospective Studies[MESH]
  • |Risk Factors[MESH]
  • |Severity of Illness Index[MESH]
  • |Triage[MESH]


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