Outcomes for emergency department patients with suspected and confirmed COVID-19: An analysis of the Australian experience in 2020 (COVED-5)

doi:10.1111/1742-6723.13837

. 2021 Oct;33(5):911-921.

doi: 10.1111/1742-6723.13837. Epub 2021 Aug 13.

Outcomes for emergency department patients with suspected and confirmed COVID-19: An analysis of the Australian experience in 2020 (COVED-5)

Gerard M O'Reilly^{1

2

3}, Rob D Mitchell^{1

2}, Biswadev Mitra^{1

2

3}, Hamed Akhlaghi^{4

5}, Viet Tran^{6

7

8}, Jeremy S Furyk^{9

10}, Paul Buntine^{11

12}, Anselm Wong^{13

14

15}, Vinay Gangathimmaiah¹⁶, Jonathan Knott^{14

17}, Allison Moore¹⁸, Jung Ro Ahn¹⁹, Quillan Chan¹⁹, Andrew Wang¹⁹, Han Goh⁴, Ashley Loughman^{6

20}, Nicole Lowry⁹, Liam Hackett¹¹, Muhuntha Sri-Ganeshan¹³, Nicole Chapman¹⁶, Maximilian Raos¹⁸, Michael P Noonan^{1

3

21}, De Villiers Smit^{1

2

3}, Peter A Cameron^{1

2}; COVED Project Team

Affiliations

¹ Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia.
² School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
³ National Trauma Research Institute, Alfred Health, Melbourne, Victoria, Australia.
⁴ Emergency Department, St Vincent's Hospital, Melbourne, Victoria, Australia.
⁵ Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.
⁶ Emergency Department, Royal Hobart Hospital, Hobart, Tasmania, Australia.
⁷ Tasmanian School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.
⁸ Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
⁹ Emergency Department, Barwon Health, Geelong, Victoria, Australia.
¹⁰ School of Medicine, Deakin University, Geelong, Victoria, Australia.
¹¹ Emergency Department, Eastern Health, Melbourne, Victoria, Australia.
¹² Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.
¹³ Emergency Department, Austin Hospital, Melbourne, Victoria, Australia.
¹⁴ Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.
¹⁵ School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.
¹⁶ Emergency Department, Townsville University Hospital, Townsville, Queensland, Australia.
¹⁷ Emergency Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
¹⁸ Emergency Department, Sutherland Hospital, Sydney, New South Wales, Australia.
¹⁹ Central Clinical School, Monash University, Melbourne, Victoria, Australia.
²⁰ Ambulance Tasmania, Hobart, Tasmania, Australia.
²¹ Trauma Service, Alfred Health, Melbourne, Victoria, Australia.

PMID: 34312991
PMCID: PMC8420351
DOI: 10.1111/1742-6723.13837

Outcomes for emergency department patients with suspected and confirmed COVID-19: An analysis of the Australian experience in 2020 (COVED-5)

Gerard M O'Reilly et al. Emerg Med Australas. 2021 Oct.

. 2021 Oct;33(5):911-921.

doi: 10.1111/1742-6723.13837. Epub 2021 Aug 13.

Authors

Affiliations

¹ Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia.
² School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
³ National Trauma Research Institute, Alfred Health, Melbourne, Victoria, Australia.
⁴ Emergency Department, St Vincent's Hospital, Melbourne, Victoria, Australia.
⁵ Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.
⁶ Emergency Department, Royal Hobart Hospital, Hobart, Tasmania, Australia.
⁷ Tasmanian School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.
⁸ Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
⁹ Emergency Department, Barwon Health, Geelong, Victoria, Australia.
¹⁰ School of Medicine, Deakin University, Geelong, Victoria, Australia.
¹¹ Emergency Department, Eastern Health, Melbourne, Victoria, Australia.
¹² Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.
¹³ Emergency Department, Austin Hospital, Melbourne, Victoria, Australia.
¹⁴ Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.
¹⁵ School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.
¹⁶ Emergency Department, Townsville University Hospital, Townsville, Queensland, Australia.
¹⁷ Emergency Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
¹⁸ Emergency Department, Sutherland Hospital, Sydney, New South Wales, Australia.
¹⁹ Central Clinical School, Monash University, Melbourne, Victoria, Australia.
²⁰ Ambulance Tasmania, Hobart, Tasmania, Australia.
²¹ Trauma Service, Alfred Health, Melbourne, Victoria, Australia.

PMID: 34312991
PMCID: PMC8420351
DOI: 10.1111/1742-6723.13837

Abstract

Objective: The aim of the present study was to describe the characteristics and outcomes of patients presenting to Australian EDs with suspected and confirmed COVID-19 during 2020, and to determine the predictors of in-hospital death for SARS-CoV-2 positive patients.

Methods: This analysis from the COVED Project presents data from 12 sites across four Australian states for the period from 1 April to 30 November 2020. All adult patients who met local criteria for suspected COVID-19 and underwent testing for SARS-CoV-2 in the ED were eligible for inclusion. Study outcomes were mechanical ventilation and in-hospital mortality.

Results: Among 24 405 eligible ED presentations over the whole study period, 423 tested positive for SARS-CoV-2. During the 'second wave' from 1 July to 30 September 2020, 26 (6%) of 406 SARS-CoV-2 patients received invasive mechanical ventilation, compared to 175 (2%) of the 9024 SARS-CoV-2 negative patients (odds ratio [OR] 3.5; 95% confidence interval [CI] 2.3-5.2, P < 0.001), and 41 (10%) SARS-CoV-2 positive patients died in hospital compared to 312 (3%) SARS-CoV-2 negative patients (OR 3.2; 95% CI 2.2-4.4, P = 0.001). For SARS-CoV-2 positive patients, the strongest independent predictors of hospital death were age (OR 1.1; 95% CI 1.1-1.1, P < 0.001), higher triage category (OR 3.5; 95% CI 1.3-9.4, P = 0.012), obesity (OR 4.2; 95% CI 1.2-14.3, P = 0.024) and receiving immunosuppressive treatment (OR 8.2; 95% CI 1.8-36.7, P = 0.006).

Conclusions: ED patients who tested positive for SARS-CoV-2 had higher odds of mechanical ventilation and death in hospital. The strongest predictors of death were age, a higher triage category, obesity and receiving immunosuppressive treatment.

Keywords: COVID-19; emergency; isolation; quality improvement; registry.

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Figures

**Figure 1**
Number of cases who died in hospital *versus* survived to hospital discharge by age.

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Cited by

Characteristics and predictors of severe outcomes of COVID-19 cases presenting to the emergency department of a major Australian referral hospital: A record linkage study.
Boldt K, Rose N, Ware S, Dinh MM, Paul KK, Ho Y, Muscatello DJ. Boldt K, et al. Emerg Med Australas. 2025 Apr;37(2):e70040. doi: 10.1111/1742-6723.70040. Emerg Med Australas. 2025. PMID: 40207594 Free PMC article.

References

1. World Health Organization . Tracking SARS‐CoV‐2 variants. [Cited 17 Jul 2021.] Available from URL: https://www.who.int/en/activities/tracking-SARS-CoV-2-variants/
1. Chakraborty D, Agrawal A, Maiti S. Rapid identification and tracking of SARS‐CoV‐2 variants of concern. Lancet 2021; 397: 1346–7. - PMC - PubMed
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[1] World Health Organization . Tracking SARS‐CoV‐2 variants. [Cited 17 Jul 2021.] Available from URL: https://www.who.int/en/activities/tracking-SARS-CoV-2-variants/

[2] World Health Organization . Tracking SARS‐CoV‐2 variants. [Cited 17 Jul 2021.] Available from URL: https://www.who.int/en/activities/tracking-SARS-CoV-2-variants/

[3] Chakraborty D, Agrawal A, Maiti S. Rapid identification and tracking of SARS‐CoV‐2 variants of concern. Lancet 2021; 397: 1346–7. - PMC - PubMed

[4] Chakraborty D, Agrawal A, Maiti S. Rapid identification and tracking of SARS‐CoV‐2 variants of concern. Lancet 2021; 397: 1346–7. - PMC - PubMed

[5] Sheikh A, McMenamin J, Taylor B, Robertson C. SARS‐CoV‐2 Delta VOC in Scotland: demographics, risk of hospital admission, and vaccine effectiveness. Lancet 2021; 397: 2461–2. - PMC - PubMed

[6] Sheikh A, McMenamin J, Taylor B, Robertson C. SARS‐CoV‐2 Delta VOC in Scotland: demographics, risk of hospital admission, and vaccine effectiveness. Lancet 2021; 397: 2461–2. - PMC - PubMed

[7] COVID‐19 National Incident Room Surveillance Team. COVID‐19 Australia: epidemiology report 45: reporting period ending 4 July 2021. Commun. Dis. Intell. (2018) 2021; 45. - PubMed

[8] COVID‐19 National Incident Room Surveillance Team. COVID‐19 Australia: epidemiology report 45: reporting period ending 4 July 2021. Commun. Dis. Intell. (2018) 2021; 45. - PubMed

[9] Lane CR, Sherry NL, Porter AF et al. Genomics‐informed responses in the elimination of COVID‐19 in Victoria, Australia: an observational, genomic epidemiological study. Lancet Public Health 2021; 6: E547–56. - PMC - PubMed

[10] Lane CR, Sherry NL, Porter AF et al. Genomics‐informed responses in the elimination of COVID‐19 in Victoria, Australia: an observational, genomic epidemiological study. Lancet Public Health 2021; 6: E547–56. - PMC - PubMed

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Outcomes for emergency department patients with suspected and confirmed COVID-19: An analysis of the Australian experience in 2020 (COVED-5)

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Outcomes for emergency department patients with suspected and confirmed COVID-19: An analysis of the Australian experience in 2020 (COVED-5)

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