Emergency department characteristics and associations with intensive care admission among patients with coronavirus disease 2019
Abstract Objective There have been few descriptions in the literature to date specifically examining initial coronavirus disease 2019 (COVID‐19) patient presentation to the emergency department (ED) and the trajectory of patients who develop critical illness. Here we describe the ED presentation and...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-02-01
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| Series: | Journal of the American College of Emergency Physicians Open |
| Online Access: | https://doi.org/10.1002/emp2.12350 |
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| author | Joshua Krieger Flynn McGuire Erik Risa August Longino Steven Coppess Toni Riveros Chris Hebert James Town Pavan Bhatraju Nicholas Johnson |
| author_facet | Joshua Krieger Flynn McGuire Erik Risa August Longino Steven Coppess Toni Riveros Chris Hebert James Town Pavan Bhatraju Nicholas Johnson |
| author_sort | Joshua Krieger |
| collection | DOAJ |
| description | Abstract Objective There have been few descriptions in the literature to date specifically examining initial coronavirus disease 2019 (COVID‐19) patient presentation to the emergency department (ED) and the trajectory of patients who develop critical illness. Here we describe the ED presentation and outcomes of patients with COVID‐19 presenting during our initial local surge. Methods This is a multicenter, retrospective cohort study using data extracted from the electronic health records at 3 hospitals within a single health system from March 1, 2020 to June 1, 2020. Patients were included in the study if they presented to an ED and had laboratory‐confirmed severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection during the study period. Data elements were extracted from the electronic health record electronically and by trained data abstractors and entered into a secure database. We used multivariable regression analysis to examine ED factors associated with the development of critical illness and mortality, with a primary outcome of ICU admission. Results A total of 330 patients with laboratory‐confirmed SARS‐CoV‐2 infection were admitted during the study period. Of these, 112 (34%) were admitted to the ICU. Among these patients, 20% were female, 50% were White, the median age was 61 (interquartile range [IQR], 52–72), and the median body mass index (BMI) was 28.1 (IQR, 24.3–35.1). On univariable analysis, a doubling of lactate dehydrogenase (LDH) (odds ratio [OR], 3.87; 95% confidence interval [CI], 2.40–6.27) or high‐sensitivity C‐reactive protein (hsCRP; OR, 1.32; 95% CI, 1.11–1.57) above the reference range or elevated troponin (OR, 12.1; 95% CI, 1.20–121.8) were associated with ICU admission. After adjusting for age, sex, and BMI, LDH was the best predictor of ICU admission (OR, 3.54; 95% CI, 2.12–5.90). Of the patients, 15% required invasive mechanical ventilation during their hospital course, and in‐hospital mortality was 19%. Conclusions Nearly one‐third of ED patients who required hospitalization for COVID‐19 were admitted to the ICU, 15% received invasive mechanical ventilation, and 19% died. Most patients who were admitted from the ED were tachypneic with elevated inflammatory markers, and the following factors were associated with ICU admission: elevated hsCRP, LDH, and troponin as well as lower oxygen saturation and increased respiratory rate. |
| format | Article |
| id | doaj-art-0ffc9480b8354f7085ebf9f8edd652fc |
| institution | OA Journals |
| issn | 2688-1152 |
| language | English |
| publishDate | 2021-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj-art-0ffc9480b8354f7085ebf9f8edd652fc2025-08-20T02:15:41ZengElsevierJournal of the American College of Emergency Physicians Open2688-11522021-02-0121n/an/a10.1002/emp2.12350Emergency department characteristics and associations with intensive care admission among patients with coronavirus disease 2019Joshua Krieger0Flynn McGuire1Erik Risa2August Longino3Steven Coppess4Toni Riveros5Chris Hebert6James Town7Pavan Bhatraju8Nicholas Johnson9Department of Pulmonary Critical Care and Sleep Medicine University of Washington Medical Center Seattle Washington USASchool of Medicine University of Washington Medical Center Seattle Washington USASchool of Medicine University of Washington Medical Center Seattle Washington USASchool of Medicine University of Washington Medical Center Seattle Washington USADepartment of Emergency Medicine University of Washington Medical Center Seattle Washington USADepartment of Pulmonary Critical Care and Sleep Medicine University of Washington Medical Center Seattle Washington USADepartment of Pulmonary Critical Care and Sleep Medicine University of Washington Medical Center Seattle Washington USADepartment of Pulmonary Critical Care and Sleep Medicine University of Washington Medical Center Seattle Washington USADepartment of Pulmonary Critical Care and Sleep Medicine University of Washington Medical Center Seattle Washington USADepartment of Pulmonary Critical Care and Sleep Medicine University of Washington Medical Center Seattle Washington USAAbstract Objective There have been few descriptions in the literature to date specifically examining initial coronavirus disease 2019 (COVID‐19) patient presentation to the emergency department (ED) and the trajectory of patients who develop critical illness. Here we describe the ED presentation and outcomes of patients with COVID‐19 presenting during our initial local surge. Methods This is a multicenter, retrospective cohort study using data extracted from the electronic health records at 3 hospitals within a single health system from March 1, 2020 to June 1, 2020. Patients were included in the study if they presented to an ED and had laboratory‐confirmed severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection during the study period. Data elements were extracted from the electronic health record electronically and by trained data abstractors and entered into a secure database. We used multivariable regression analysis to examine ED factors associated with the development of critical illness and mortality, with a primary outcome of ICU admission. Results A total of 330 patients with laboratory‐confirmed SARS‐CoV‐2 infection were admitted during the study period. Of these, 112 (34%) were admitted to the ICU. Among these patients, 20% were female, 50% were White, the median age was 61 (interquartile range [IQR], 52–72), and the median body mass index (BMI) was 28.1 (IQR, 24.3–35.1). On univariable analysis, a doubling of lactate dehydrogenase (LDH) (odds ratio [OR], 3.87; 95% confidence interval [CI], 2.40–6.27) or high‐sensitivity C‐reactive protein (hsCRP; OR, 1.32; 95% CI, 1.11–1.57) above the reference range or elevated troponin (OR, 12.1; 95% CI, 1.20–121.8) were associated with ICU admission. After adjusting for age, sex, and BMI, LDH was the best predictor of ICU admission (OR, 3.54; 95% CI, 2.12–5.90). Of the patients, 15% required invasive mechanical ventilation during their hospital course, and in‐hospital mortality was 19%. Conclusions Nearly one‐third of ED patients who required hospitalization for COVID‐19 were admitted to the ICU, 15% received invasive mechanical ventilation, and 19% died. Most patients who were admitted from the ED were tachypneic with elevated inflammatory markers, and the following factors were associated with ICU admission: elevated hsCRP, LDH, and troponin as well as lower oxygen saturation and increased respiratory rate.https://doi.org/10.1002/emp2.12350 |
| spellingShingle | Joshua Krieger Flynn McGuire Erik Risa August Longino Steven Coppess Toni Riveros Chris Hebert James Town Pavan Bhatraju Nicholas Johnson Emergency department characteristics and associations with intensive care admission among patients with coronavirus disease 2019 Journal of the American College of Emergency Physicians Open |
| title | Emergency department characteristics and associations with intensive care admission among patients with coronavirus disease 2019 |
| title_full | Emergency department characteristics and associations with intensive care admission among patients with coronavirus disease 2019 |
| title_fullStr | Emergency department characteristics and associations with intensive care admission among patients with coronavirus disease 2019 |
| title_full_unstemmed | Emergency department characteristics and associations with intensive care admission among patients with coronavirus disease 2019 |
| title_short | Emergency department characteristics and associations with intensive care admission among patients with coronavirus disease 2019 |
| title_sort | emergency department characteristics and associations with intensive care admission among patients with coronavirus disease 2019 |
| url | https://doi.org/10.1002/emp2.12350 |
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