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. 2021 Nov 5;22(6):1257-1261.
doi: 10.5811/westjem.2021.9.52824.

Clinical Characteristics Associated with Return Visits to the Emergency Department after COVID-19 Diagnosis

Iltifat Husain  1 , James O'Neill  1 , Rachel Mudge  1 , Alicia Bishop  1 , K Alexander Soltany  1 , Jesse Heinen  1 , Chase Countryman  1 , Dillon Casey  1 , David Cline  1
Affiliations

Clinical Characteristics Associated with Return Visits to the Emergency Department after COVID-19 Diagnosis

Iltifat Husain et al. West J Emerg Med. .

Abstract

Introduction: Patients diagnosed with coronavirus disease 2019 (COVID-19) require significant healthcare resources. While published research has shown clinical characteristics associated with severe illness from COVID-19, there is limited data focused on the emergency department (ED) discharge population.

Methods: We performed a retrospective chart review of all ED-discharged patients from Wake Forest Baptist Health and Wake Forest Baptist Health Davie Medical Center between April 25-August 9, 2020, who tested positive for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) from a nasopharyngeal swab using real-time reverse transcription polymerase chain reaction (rRT-PCR) tests. We compared the clinical characteristics of patients who were discharged and had return visits within 30 days to those patients who did not return to the ED within 30 days.

Results: Our study included 235 adult patients who had an ED-performed SARS-CoV-2 rRT-PCR positive test and were subsequently discharged on their first ED visit. Of these patients, 57 (24.3%) had return visits to the ED within 30 days for symptoms related to COVID-19. Of these 57 patients, on return ED visits 27 were admitted to the hospital and 30 were not admitted. Of the 235 adult patients who were discharged, 11.5% (27) eventually required admission for COVID-19-related symptoms. With 24.3% patients having a return ED visit after a positive SARS-CoV-2 test and 11.5% requiring eventual admission, it is important to understand clinical characteristics associated with return ED visits. We performed multivariate logistic regression analysis of the clinical characteristics with independent association resulting in a return ED visit, which demonstrated the following: diabetes (odds ratio [OR] 2.990, 95% confidence interval [CI, 1.21-7.40, P = 0.0179); transaminitis (OR 8.973, 95% CI, 2.65-30.33, P = 0.004); increased pulse at triage (OR 1.04, 95% CI, 1.02-1.07, P = 0.0002); and myalgia (OR 4.43, 95% CI, 2.03-9.66, P = 0.0002).

Conclusion: As EDs across the country continue to treat COVID-19 patients, it is important to understand the clinical factors associated with ED return visits related to SARS-CoV-2 infection. We identified key clinical characteristics associated with return ED visits for patients initially diagnosed with SARS-CoV-2 infection: diabetes mellitus; increased pulse at triage; transaminitis; and complaint of myalgias.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

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