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. 2023 Apr 3;24(3):405-415.
doi: 10.5811/westjem.58717.

Characteristics of Suspected COVID-19 Discharged Emergency Department Patients Who Returned During the First Wave

Jonathan Gong  1 , Rene Mayorga  2 , Roland Hentz  3 , Martin Lesser  3   4 , Seleshi Demissie  3 , Frederick Davis  1 , Adam Berman  1 , Matthew Barish  5 , Stuart L Cohen  5 , Kate L van Loveren  1 , Nancy S Kwon  1 ; Northwell COVID-19 Research Consortium
Affiliations

Characteristics of Suspected COVID-19 Discharged Emergency Department Patients Who Returned During the First Wave

Jonathan Gong et al. West J Emerg Med. .

Abstract

Introduction: Limited information exists on patients with suspected coronavirus disease 2019 (COVID-19) who return to the emergency department (ED) during the first wave. In this study we aimed to identify predictors of ED return within 72 hours for patients with suspected COVID-19.

Methods: Incorporating data from 14 EDs within an integrated healthcare network in the New York metropolitan region from March 2-April 27, 2020, we analyzed this data on predictors for a return ED visit-including demographics, comorbidities, vital signs, and laboratory results.

Results: In total, 18,599 patients were included in the study. The median age was 46 years old [interquartile range 34-58]), 50.74% were female, and 49.26% were male. Overall, 532 (2.86%) returned to the ED within 72 hours, and 95.49% were admitted at the return visit. Of those tested for COVID-19, 59.24% (4704/7941) tested positive. Patients with chief complaints of "fever" or "flu" or a history of diabetes or renal disease were more likely to return at 72 hours. Risk of return increased with persistently abnormal temperature (odds ratio [OR] 2.43, 95% CI 1.8-3.2), respiratory rate (2.17, 95% CI 1.6-3.0), and chest radiograph (OR 2.54, 95% CI 2.0-3.2). Abnormally high neutrophil counts, low platelet counts, high bicarbonate values, and high aspartate aminotransferase levels were associated with a higher rate of return. Risk of return decreased when discharged on antibiotics (OR 0.12, 95% CI 0.0-0.3) or corticosteroids (OR 0.12, 95% CI 0.0-0.9).

Conclusion: The low overall return rate of patients during the first COVID-19 wave indicates that physicians' clinical decision-making successfully identified those acceptable for discharge.

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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. Funding for this work was supported by grants R24AG064191 from the National Institute on Aging of the National Institutes of Health (NIH) and R01LM012836 from the National Library of Medicine of the NIH. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. The views expressed in this paper are those of the authors and do not represent the views of the NIH, the US Department of Health and Human Services, or any other government entity. There are no conflicts of interest to declare.

Figures

Figure 1
Figure 1
A. Eligibility criteria for study sample (N=18,599). B. Historical data on emergency department 72-hour return and admission from 2019 for patients presenting with respiratory symptoms. COVID-19, coronavirus 2019; ED, emergency department.
See this image and copyright information in PMC

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