TY - JOUR
T1 - Outcomes for emergency department patients with suspected and confirmed COVID-19
T2 - An analysis of the Australian experience in 2020 (COVED-5)
AU - O'Reilly, Gerard M.
AU - Mitchell, Rob D.
AU - Mitra, Biswadev
AU - Akhlaghi, Hamed
AU - Tran, Viet
AU - Furyk, Jeremy S.
AU - Buntine, Paul
AU - Wong, Anselm
AU - Gangathimmaiah, Vinay
AU - Knott, Jonathan
AU - Moore, Allison
AU - Ahn, Jung Ro
AU - Chan, Quillan
AU - Wang, Andrew
AU - Goh, Han
AU - Loughman, Ashley
AU - Lowry, Nicole
AU - Hackett, Liam
AU - Sri-Ganeshan, Muhuntha
AU - Chapman, Nicole
AU - Raos, Maximilian
AU - Noonan, Michael P.
AU - Smit, De Villiers
AU - Cameron, Peter A.
AU - on behalf of the COVED Project Team
N1 - Funding Information:
GMOR is currently a NHMRC Research Fellow at the National Trauma Research Institute, Alfred Hospital, Melbourne, Australia, leading the project titled: ‘Maximising the usefulness and timeliness of trauma and emergency registry data for improving patient outcomes’ (GNT1142691). RDM is supported by a National Health and Medical Research Council Postgraduate Scholarship and Monash University Graduate Excellence Scholarship. PAC is funded by a MRFF practitioner fellowship (MRF1139686). AW is supported by a NHMRC Research Fellowship ID 1159907. NC is funded by a research grant from Study, Education and Research Trust Account of Townsville Hospital and Health Service.
Publisher Copyright:
© 2021 Australasian College for Emergency Medicine
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/8
Y1 - 2021/8
N2 - Objective: The aim of the present study was to describe the characteristics and outcomes of patients presenting to Australian EDs with suspected and confirmed COVID-19 during 2020, and to determine the predictors of in-hospital death for SARS-CoV-2 positive patients. Methods: This analysis from the COVED Project presents data from 12 sites across four Australian states for the period from 1 April to 30 November 2020. All adult patients who met local criteria for suspected COVID-19 and underwent testing for SARS-CoV-2 in the ED were eligible for inclusion. Study outcomes were mechanical ventilation and in-hospital mortality. Results: Among 24 405 eligible ED presentations over the whole study period, 423 tested positive for SARS-CoV-2. During the ‘second wave’ from 1 July to 30 September 2020, 26 (6%) of 406 SARS-CoV-2 patients received invasive mechanical ventilation, compared to 175 (2%) of the 9024 SARS-CoV-2 negative patients (odds ratio [OR] 3.5; 95% confidence interval [CI] 2.3–5.2, P < 0.001), and 41 (10%) SARS-CoV-2 positive patients died in hospital compared to 312 (3%) SARS-CoV-2 negative patients (OR 3.2; 95% CI 2.2–4.4, P = 0.001). For SARS-CoV-2 positive patients, the strongest independent predictors of hospital death were age (OR 1.1; 95% CI 1.1–1.1, P < 0.001), higher triage category (OR 3.5; 95% CI 1.3–9.4, P = 0.012), obesity (OR 4.2; 95% CI 1.2–14.3, P = 0.024) and receiving immunosuppressive treatment (OR 8.2; 95% CI 1.8–36.7, P = 0.006). Conclusions: ED patients who tested positive for SARS-CoV-2 had higher odds of mechanical ventilation and death in hospital. The strongest predictors of death were age, a higher triage category, obesity and receiving immunosuppressive treatment.
AB - Objective: The aim of the present study was to describe the characteristics and outcomes of patients presenting to Australian EDs with suspected and confirmed COVID-19 during 2020, and to determine the predictors of in-hospital death for SARS-CoV-2 positive patients. Methods: This analysis from the COVED Project presents data from 12 sites across four Australian states for the period from 1 April to 30 November 2020. All adult patients who met local criteria for suspected COVID-19 and underwent testing for SARS-CoV-2 in the ED were eligible for inclusion. Study outcomes were mechanical ventilation and in-hospital mortality. Results: Among 24 405 eligible ED presentations over the whole study period, 423 tested positive for SARS-CoV-2. During the ‘second wave’ from 1 July to 30 September 2020, 26 (6%) of 406 SARS-CoV-2 patients received invasive mechanical ventilation, compared to 175 (2%) of the 9024 SARS-CoV-2 negative patients (odds ratio [OR] 3.5; 95% confidence interval [CI] 2.3–5.2, P < 0.001), and 41 (10%) SARS-CoV-2 positive patients died in hospital compared to 312 (3%) SARS-CoV-2 negative patients (OR 3.2; 95% CI 2.2–4.4, P = 0.001). For SARS-CoV-2 positive patients, the strongest independent predictors of hospital death were age (OR 1.1; 95% CI 1.1–1.1, P < 0.001), higher triage category (OR 3.5; 95% CI 1.3–9.4, P = 0.012), obesity (OR 4.2; 95% CI 1.2–14.3, P = 0.024) and receiving immunosuppressive treatment (OR 8.2; 95% CI 1.8–36.7, P = 0.006). Conclusions: ED patients who tested positive for SARS-CoV-2 had higher odds of mechanical ventilation and death in hospital. The strongest predictors of death were age, a higher triage category, obesity and receiving immunosuppressive treatment.
KW - COVID-19
KW - emergency
KW - isolation
KW - quality improvement
KW - registry
UR - http://www.scopus.com/inward/record.url?scp=85113139400&partnerID=8YFLogxK
U2 - 10.1111/1742-6723.13837
DO - 10.1111/1742-6723.13837
M3 - Article
C2 - 34312991
AN - SCOPUS:85113139400
SN - 1742-6731
VL - 33
SP - 911
EP - 921
JO - EMA - Emergency Medicine Australasia
JF - EMA - Emergency Medicine Australasia
IS - 5
ER -