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Observational Study
. 2025 Jan 23;25(1):11.
doi: 10.1186/s12873-024-01164-x.

Predictors of specialist care referrals (SCR) following emergency department review or hospital admission in adults with previous acute COVID-19: a prospective UK cohort study

Anita Saigal #  1   2 , Songyuan Xiao #  3 , Owais Siddique  3 , Prasheena Naran  4 , Heba M Bintalib  3   5   6 , Camila Nagoda Niklewicz  4 , George Seligmann  4 , Sindhu Bhaarrati Naidu  3   4 , Amar J Shah  3   4 , Chibueze Ogbonnaya  7 , John R Hurst  3   4 , Marc Ci Lipman  3   4 , Swapna Mandal  3   4
Affiliations
Observational Study

Predictors of specialist care referrals (SCR) following emergency department review or hospital admission in adults with previous acute COVID-19: a prospective UK cohort study

Anita Saigal et al. BMC Emerg Med. .

Abstract

Background: Long-COVID research to date focuses on outcomes in non-hospitalised vs. hospitalised survivors. However Emergency Department attendees (post-ED) presenting with acute COVID-19 may experience less supported recovery compared to people admitted and discharged from hospital (post-hospitalised group, PH).

Objective: We evaluated outcomes and predictors of specialty care referrals (SCR) in those with ongoing symptomatic Long-COVID, comparing post-ED and PH adults.

Methods: This prospective observational cohort study evaluates 800 PH and 484 post-ED adults from a single hospital in London, United Kingdom. Participants had either confirmed laboratory-positive SARS-CoV-2 infection or clinically suspected acute COVID-19 and were offered post-COVID clinical follow-up at approximately six weeks after their ED attendance or inpatient discharge, to assess ongoing symptoms and support recovery. Multiple logistic regression determined associations with specialist care referrals (SCR) to respiratory, cardiology, physiotherapy (including chest physiotherapy), and mental health services.

Results: Presence of at least one Long-COVID symptom was lower in adults attending ED services with acute COVID-19 compared to those hospitalised (70.1% post-ED vs. 79.5% PH adults, p < 0.001). Total number of Long-COVID symptoms was associated with increased SCR in all patients (adjusted odds ratio (aOR) = 1.26, 95%CI:1.16, 1.36, p < 0.001), with post-ED adults more likely to need a SCR overall (aOR = 1.82, 95%CI:1.19, 2.79, p = 0.006). Post-ED adults had higher SCR to both physiotherapy (aOR = 2.59, 95%CI:1.35, 4.96, p = 0.004) and mental health services (aOR = 3.84, 95%CI:2.00, 7.37, p < 0.001), with pre-existing mental illness linked to the latter (aOR = 4.08, 95%CI:1.07, 15.6, p = 0.04).

Conclusions: We demonstrate greater specialist care referrals to mental health and physiotherapy services in patients attending the ED and discharged with acute COVID-19, compared to those admitted, despite lower ongoing COVID-19 symptom burden. Total number of symptoms, pre-existing co-morbidity such as smoking status, cardiac co-morbidities, and mental health illnesses may predict those requiring healthcare input. This information may enable better post-COVID support for ED attendees, a distinct group who should not be neglected when preparing for future pandemics.

Trial registration: This study had HRA approval (20/HRA/4928).

Keywords: Emergency department; Long-COVID; Ongoing symptomatic COVID-19; SARS-CoV-2.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study had UK Health Research Authority (HRA) and Health and Care Research Wales approval (HRA number 20/HRA/4928). All participants consented to participate in the study at their initial follow-up consultation. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study participants in post-hospitalised (PH) and post-emergency department (post-ED) groups
See this image and copyright information in PMC

References

    1. National Institute for Health and Care Excellence. COVID-19 rapid guideline: managing the long-term effects of COVID-19. [Internet]. [London]: NICE; 2022 [updated 2022 Nov, cited 2023 Jul 7]. (Clinical guideline [NG188]). Available from: https://www.nice.org.uk/guidance/ng188/
    1. World Health Organisation. Clinical management of COVID-19: Living Guideline. [Internet]. [Geneva]: WHO; 2023 [updated 2023 Jan, cited 2023 Jul 7]. (WHO reference number [WHO/2019-nCoV/clinical/2023.1]). Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2023.1
    1. Heightman M, Prashar J, Hillman TE et al. Post-COVID-19 assessment in a specialist clinical service: a 12-month, single-centre, prospective study in 1325 individuals [published correction appears in BMJ Open Respir Res. 2022;9(1):]. BMJ Open Respir Res. 2021;8(1):e001041. 10.1136/bmjresp-2021-001041 - PMC - PubMed
    1. Lanham D, Roe J, Chauhan A, et al. COVID-19 emergency department discharges: an outcome study. Clin Med (Lond). 2021;21(2):e126–31. 10.7861/clinmed.2020-0817. - PMC - PubMed
    1. Decary S, Dugas M, Stefan T, Langlois L, Skidmore B, Bhéreur A, LeBlanc A. Care models for long COVID – a living systematic review. First update – December 2021. SPOR Evidence Alliance, COVID-END Network; 2021.

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