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. 2021 Oct 8;10(19):4605.
doi: 10.3390/jcm10194605.

A Retrospective Cohort Study of Clinical Factors Associated with Transitions of Care among COVID-19 Patients

Dennis Swearingen  1   2 , Gregory Boverman  3 , Kristen Tgavalekos  3 , David P Noren  3 , Shreyas Ravindranath  3 , Erina Ghosh  3 , Minnan Xu  3 , Lisa Wondrely  3 , Pam Thompson  1 , J David Cowden  1 , Corneliu Antonescu  1   2
Affiliations

A Retrospective Cohort Study of Clinical Factors Associated with Transitions of Care among COVID-19 Patients

Dennis Swearingen et al. J Clin Med. .

Abstract

Coronavirus Disease 2019 (COVID-19) is an international health crisis. In this article, we report on patient characteristics associated with care transitions of: 1) hospital admission from the emergency department (ED) and 2) escalation to the intensive care unit (ICU). Analysis of data from the electronic medical record (EMR) was performed for patients with COVID-19 seen in the ED of a large Western U.S. Health System from April to August of 2020, totaling 10,079 encounters. Of these, 5172 resulted in admission as an inpatient within 72 h. Inpatient encounters (n = 6079) were also considered for patients with positive COVID-19 test results, of which 970 resulted in a transfer to the ICU or in-hospital mortality. Laboratory results, vital signs, symptoms, and comorbidities were investigated for each of these care transitions. Different top risk factors were found, but two factors common to hospital admission and ICU transfer were respiratory rate and the need for oxygen support. Comorbidities common to both settings were cerebrovascular disease and congestive heart failure. Regarding laboratory results, the neutrophil-to-lymphocyte ratio was associated with transitions to higher levels of care, along with the ratio of aspartate aminotransferase (AST) to alanine aminotransferase (ALT).

Keywords: COVID-19; care transitions; triage.

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Conflict of interest statement

Greg Boverman, K.T., David Noren, Shreyas Ravindranath, Erina Ghosh, Minnan Xu, Lisa Wondrely are employees of Philips, a medical device company.

Figures

Figure A1
Figure A1
Logistic regression log odds ratios of comorbidities for Comparison 1 (ED admission) adjusted for age.
Figure A2
Figure A2
Logistic regression log-odds ratio correlating comorbidities to the outcome for comparison 2: (a) Raw log odds ratios and (b) Controlled for age.
Figure A3
Figure A3
Logistic log-odds coefficients correlating comorbidities to the outcome for Comparison 3 (inpatient deterioration), controlling for age.
Figure 1
Figure 1
Graphical depiction of COVID patient flow through the healthcare system. Blue circles (nodes) represent location types within the system. Grey circles represent discharge dispositions. Circle diameters are proportional to the (natural log of the) number of patients who passed through a location type at least once during an encounter. Line (edge) widths are linearly proportional to the number of times a transition occurred and the edges are also labeled with this number. The “Misc. loc.” node stands for miscellaneous locations that have been grouped together due to low counts and for privacy purposes. The “Misc. disch.” node stands for miscellaneous discharge dispositions that have been grouped together. For visualization and privacy purposes, transitions are only shown when they have more than 100 counts.
Figure 2
Figure 2
CONSORT diagram for patients included in the study.
Figure 3
Figure 3
Univariate and multivariate logistic regression coefficients for comparisons 1 (a) ED admission and 2 (b) ED bounce-back.
Figure 4
Figure 4
Univariate and multivariate regression coefficients for comparison 3 (a) 12 h prior to the event and (b) 4 h prior to the event.
See this image and copyright information in PMC

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