vomiting, patients with history or family history of chronic disease, disorders of lipid metabolism, and myocardial infarction presentations in 2020 compared to 2019. Dispositions also significantly differed in 2020 compared to 2019 with more patients receiving admission or dying in the ED (p<0.001). Patients who presented to the ED often presented with more severe illness in 2020 as reflected in increased length of stay in 2020 (p¼0.01) and increased case-medical-index (p<0.001).Conclusion: The COVID-19 pandemic significantly reduced the total number of ED visits to HMC in Flint, Michigan in 2020, when compared to the same time period in 2019. Notably, patients were more likely to have a longer length-of-stay, present with more severe illness, and more likely to be admitted or pass away in the ED when compared to the same time period in 2019. Analysis also revealed that visits for respiratory diagnoses and other life-threatening conditions like myocardial infarction increased, whereas less life-threatening/acute conditions like sprains, urinary tract infections, and sexually transmitted infections decreased. Interestingly as well, the pandemic drove statistically significant increased visits for mental health and socioeconomic factors. Limitations include analyzing 6 months of data as opposed to the whole calendar year and the use of broad ICD-10 code categories. It is also important to note that diagnosis codes were analyzed versus what the patient subjectively presented for, so there is a gray area between being able to elucidate what motivated the patient to come to the ED and verus what was analyzed in this project as patient's ICD-10 diagnoses.
Background: With the rapid spread of SARS-CoV-2 across the globe, numerous authors have noted different patient characteristics that may relate to an increased admission rate to an intensive care unit (ICU). However, little data has been presented comparing these characteristics among those who receive care at either a rural or urban emergency department (ED).Study Objective: To compare the clinical characteristics and outcomes of patients with COVID-19 admitted to the ICU from rural and urban EDs.Methods: A retrospective, multi-center cohort study of adult patients who required hospitalization between March 01, 2020 and July 01, 2020 due to confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from two rural and one urban ED in Arizona were included in analysis. Research assistants who were blinded to the study hypothesis were trained on proper data abstraction prior to the collection of data by the study team. With adherence to a quality-controlled protocol and structured abstraction tool, research assistants manually collected patient demographics, ED laboratory values, initial vital signs, total hospitalizations, ICU admissions, and mortality in a with a one-to-one allocation ratio non-White and White patients. Comparisons of the comorbidities among patients transferred to the ICU in urban and rural hospitals were conducted with the chi-squared analysis. Factors that may predict transfer to the ICU were determined via a stepwise multivariable binomial logistic regression.Results: A total of 304 patients (175 urban and 129 rural) with confirmed SARS-CoV-2 infection were admitted to the hospital during the study period with 63 patients (24 urban vs 39 rural; OR¼2.1, p¼0.01) being admitted to the ICU. Of those admitted to the ICU, a total of 21 (33.3%) were female (11 urban and 10 rural). The median age of patients admitted to the ICU from the urban cohort was 66.0 years old (IQR¼35.0) and from the rural cohort was 62.6 years (IQR¼28).The most common comorbidity seen in both urban and rural patients admitted to the ICU was hypertension (12 [50%] urban; 21 [53.8%] rural). In the overall cohort, multivariable logistic regression showed an increase in the odds of ICU admission among patients presenting with concurrent bacterial infection (p¼0.043), elevated temperature (p¼0.002), respiratory rate (p¼0.003), white blood cells (p¼0.034), and reduced hemoglobin levels (p¼0.014). Across the total cohort, these factors predicted transfer to the ICU with a sensitivity of 39.5% and specificity of 95.2%.Conclusion: Patients with confirmed SARS-CoV-2 are more likely to require critical care intervention if presenting to the emergency department with concurrent bacterial infection, elevated temperature, respiratory rate, white blood cells, and reduced hemoglobin. The degree to which these factors generalize between urban and rural hospitals remains to be elucidated.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.