Epidemiology and clinical features of emergency department patients with suspected and confirmed COVID-19: A multisite report from the COVID-19 Emergency Department Quality Improvement Project for July 2020 (COVED-3)

doi:10.1111/1742-6723.13651

Multicenter Study

. 2021 Feb;33(1):114-124.

doi: 10.1111/1742-6723.13651. Epub 2020 Oct 19.

Epidemiology and clinical features of emergency department patients with suspected and confirmed COVID-19: A multisite report from the COVID-19 Emergency Department Quality Improvement Project for July 2020 (COVED-3)

Gerard M O'Reilly^{1

2

3}, Rob D Mitchell^{1

2}, Biswadev Mitra^{1

2

3}, Hamed Akhlaghi⁴, Viet Tran^{5

6}, Jeremy S Furyk^{7

8}, Paul Buntine^{9

10}, Holly Bannon-Murphy¹, Timothy Amos¹, Maushmi Udaya Kumar¹⁰, Emma Perkins¹⁰, Alexandra Prentice⁴, Olivia Szwarcberg⁴, Ashley Loughman^{5

11}, Nicole Lowry⁷, Steven Colwell⁹, Michael P Noonan^{1

3

12}, Ryan Hiller¹, Andrew Paton^{1

13}, 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 Emergency Department, Royal Hobart Hospital, Tasmanian Health Services, Hobart, Tasmania, Australia.
⁶ Tasmanian School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.
⁷ Emergency Department, Barwon Health, Geelong, Victoria, Australia.
⁸ School of Medicine, Deakin University, Melbourne, Victoria, Australia.
⁹ Emergency Department, Eastern Health, Melbourne, Victoria, Australia.
¹⁰ School of Medicine, Monash University, Melbourne, Victoria, Australia.
¹¹ Ambulance Tasmania, Hobart, Tasmania, Australia.
¹² Trauma Service, Alfred Health, Melbourne, Victoria, Australia.
¹³ Adult Retrieval Victoria, Ambulance Victoria, Melbourne, Victoria, Australia.

PMID: 32959497
PMCID: PMC7536936
DOI: 10.1111/1742-6723.13651

Multicenter Study

Epidemiology and clinical features of emergency department patients with suspected and confirmed COVID-19: A multisite report from the COVID-19 Emergency Department Quality Improvement Project for July 2020 (COVED-3)

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

. 2021 Feb;33(1):114-124.

doi: 10.1111/1742-6723.13651. Epub 2020 Oct 19.

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 Emergency Department, Royal Hobart Hospital, Tasmanian Health Services, Hobart, Tasmania, Australia.
⁶ Tasmanian School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.
⁷ Emergency Department, Barwon Health, Geelong, Victoria, Australia.
⁸ School of Medicine, Deakin University, Melbourne, Victoria, Australia.
⁹ Emergency Department, Eastern Health, Melbourne, Victoria, Australia.
¹⁰ School of Medicine, Monash University, Melbourne, Victoria, Australia.
¹¹ Ambulance Tasmania, Hobart, Tasmania, Australia.
¹² Trauma Service, Alfred Health, Melbourne, Victoria, Australia.
¹³ Adult Retrieval Victoria, Ambulance Victoria, Melbourne, Victoria, Australia.

PMID: 32959497
PMCID: PMC7536936
DOI: 10.1111/1742-6723.13651

Abstract

Objective: The aim of the present study was to describe the epidemiology and clinical features of patients presenting to the ED with suspected and confirmed COVID-19.

Methods: The COVID-19 ED (COVED) Project is an ongoing prospective cohort study in Australian EDs. This analysis presents data from eight sites across Victoria and Tasmania for July 2020 (during Australia's 'second wave'). All adult patients who met criteria for 'suspected COVID-19' and underwent testing for SARS-CoV-2 in the ED were eligible for inclusion. Study outcomes included a positive SARS-CoV-2 test result and mechanical ventilation.

Results: In the period 1 July to 31 July 2020, there were 30 378 presentations to the participating EDs and 2917 (9.6%; 95% confidence interval 9.3-9.9) underwent testing for SARS-CoV-2. Of these, 50 (2%) patients returned a positive result. Among positive cases, two (4%) received mechanical ventilation during their hospital admission compared to 45 (2%) of the SARS-CoV-2 negative patients (odds ratio 1.7, 95% confidence interval 0.4-7.3; P = 0.47). Two (4%) SARS-CoV-2 positive patients died in hospital compared to 46 (2%) of the SARS-CoV-2 negative patients (odds ratio 1.7, 95% confidence interval 0.4-7.1; P = 0.49). Strong clinical predictors of a positive SARS-CoV-2 result included self-reported fever, non-smoking status, bilateral infiltrates on chest X-ray and absence of a leucocytosis on first ED blood tests (P < 0.05).

Conclusion: In this prospective multi-site study from July 2020, a substantial proportion of ED patients required SARS-CoV-2 testing, isolation and enhanced infection prevention and control precautions. Presence of SARS-CoV-2 on nasopharyngeal swab was not associated with death or mechanical ventilation.

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

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References

1. O'Reilly GM, Mitchell RD, Mitra B et al. Impact of patient isolation on emergency department length of stay: a retrospective cohort study using the Registry for Emergency Care. Emerg. Med. Australas. 2020; 32: 1034–9. - PMC - PubMed
1. O'Reilly GM, Mitchell RD, Rajiv P et al. Epidemiology and clinical features of emergency department patients with suspected COVID‐19: initial results from the COVID‐19 Emergency Department Quality Improvement Project (COVED‐1). Emerg. Med. Australas. 2020; 32: 638–45. - PubMed
1. O'Reilly GM, Mitchell RD, Wu J et al. Epidemiology and clinical features of emergency department patients with suspected COVID‐19: results from the first month of the COVID‐19 Emergency Department Quality Improvement Project (COVED‐2). Emerg. Med. Australas. 2020; 32: 814–22. - PMC - PubMed
1. Staib A, Small N. Emergency medicine's COVID future: facing the triple challenge after flattening the curve. Emerg. Med. Australas. 2020; 32: 880–2. - PMC - PubMed
1. Cheek JA, Craig SS, West A, Lewena S, Hiscock H. Emergency department utilisation by vulnerable paediatric populations during the COVID‐19 pandemic. Emerg. Med. Australas. 2020; 32: 870–1. - PMC - PubMed

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[1] O'Reilly GM, Mitchell RD, Mitra B et al. Impact of patient isolation on emergency department length of stay: a retrospective cohort study using the Registry for Emergency Care. Emerg. Med. Australas. 2020; 32: 1034–9. - PMC - PubMed

[2] O'Reilly GM, Mitchell RD, Mitra B et al. Impact of patient isolation on emergency department length of stay: a retrospective cohort study using the Registry for Emergency Care. Emerg. Med. Australas. 2020; 32: 1034–9. - PMC - PubMed

[3] O'Reilly GM, Mitchell RD, Rajiv P et al. Epidemiology and clinical features of emergency department patients with suspected COVID‐19: initial results from the COVID‐19 Emergency Department Quality Improvement Project (COVED‐1). Emerg. Med. Australas. 2020; 32: 638–45. - PubMed

[4] O'Reilly GM, Mitchell RD, Rajiv P et al. Epidemiology and clinical features of emergency department patients with suspected COVID‐19: initial results from the COVID‐19 Emergency Department Quality Improvement Project (COVED‐1). Emerg. Med. Australas. 2020; 32: 638–45. - PubMed

[5] O'Reilly GM, Mitchell RD, Wu J et al. Epidemiology and clinical features of emergency department patients with suspected COVID‐19: results from the first month of the COVID‐19 Emergency Department Quality Improvement Project (COVED‐2). Emerg. Med. Australas. 2020; 32: 814–22. - PMC - PubMed

[6] O'Reilly GM, Mitchell RD, Wu J et al. Epidemiology and clinical features of emergency department patients with suspected COVID‐19: results from the first month of the COVID‐19 Emergency Department Quality Improvement Project (COVED‐2). Emerg. Med. Australas. 2020; 32: 814–22. - PMC - PubMed

[7] Staib A, Small N. Emergency medicine's COVID future: facing the triple challenge after flattening the curve. Emerg. Med. Australas. 2020; 32: 880–2. - PMC - PubMed

[8] Staib A, Small N. Emergency medicine's COVID future: facing the triple challenge after flattening the curve. Emerg. Med. Australas. 2020; 32: 880–2. - PMC - PubMed

[9] Cheek JA, Craig SS, West A, Lewena S, Hiscock H. Emergency department utilisation by vulnerable paediatric populations during the COVID‐19 pandemic. Emerg. Med. Australas. 2020; 32: 870–1. - PMC - PubMed

[10] Cheek JA, Craig SS, West A, Lewena S, Hiscock H. Emergency department utilisation by vulnerable paediatric populations during the COVID‐19 pandemic. Emerg. Med. Australas. 2020; 32: 870–1. - PMC - PubMed

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Epidemiology and clinical features of emergency department patients with suspected and confirmed COVID-19: A multisite report from the COVID-19 Emergency Department Quality Improvement Project for July 2020 (COVED-3)

Affiliations

Epidemiology and clinical features of emergency department patients with suspected and confirmed COVID-19: A multisite report from the COVID-19 Emergency Department Quality Improvement Project for July 2020 (COVED-3)

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