Predicting 30‐day return hospital admissions in patients with COVID‐19 discharged from the emergency department: A national retrospective cohort study

Beiser, David G.; Jarou, Zachary J.; Kassir, Alaa A.; Puskarich, Michael A.; Vrablik, Marie C.; Rosenman, Elizabeth D.; McDonald, Samuel; Meltzer, Andrew C.; Courtney, D. Mark; Kabrhel, Christopher; Kline, Jeffrey A.

doi:10.1002/emp2.12595

Cited by 6 publications

(6 citation statements)

References 26 publications

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“…In the series by Somani et al, 3.8% of patients were readmitted within 14 days 9 and 7.6% within 30 days in the study by Beiser et al 10 These two studies reported registries of patients cared for in-hospital, but without any mention of early discharge and without the need for continued home care.…”

Section: Discussionmentioning

confidence: 99%

Early Discharge, Outpatient Evaluation, and Home Management of Acute Respiratory Failure from COVID-19 in Martinique

Agossou

Provost

Barnay

et al. 2023

The American Journal of Tropical Medicine and Hygiene

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A worldwide pandemic of viral infection due to SARS-CoV-2 (and its resultant disease, COVID-19) has been ongoing since 2019. Martinique was affected by a major wave in summer 2021, with saturation of the health system forcing the implementation of home care management. We conducted a retrospective, observational study that included patients treated in the KOVIDHOM 972 program. We included adult patients with SARS-CoV2 hypoxemic pneumonia and requiring 4 L per minute or less of oxygen. In total, 418 were discharged to home with oxygen therapy after hospitalization for SARS-CoV-2 hypoxemic acute pneumonia, and 416 were analyzed. Half (50.2%) were women. Mean age was 58.8 ± 13.0 years. Time from onset of symptoms to hospitalization was 9.1 ± 3.5 days, and average length of stay was 10.5 ± 7.4 days. Maximum oxygen flow during hospitalization was 6.9 ± 4.5 L/min in patients who did not require intensive care. Average oxygen flow at discharge was 1.8 ± 07 L/min. At 30 days after discharge, the readmission rate was 0.5% (95% CI: 0–1.18), and the death rate was 0.5% (95% CI 0–1.18). Our study shows a very low rate of readmission or death in COVID-19 patients discharged to home with oxygen therapy. These results highlight the possibility of safe home care in carefully selected patients. Such programs could be useful in pandemic or wide-scale emergency situations.

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Section: Discussionmentioning

confidence: 99%

Early Discharge, Outpatient Evaluation, and Home Management of Acute Respiratory Failure from COVID-19 in Martinique

Agossou

Provost

Barnay

et al. 2023

The American Journal of Tropical Medicine and Hygiene

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“…Several prior studies used longer intervals including 7, 13 , 16 14, 14 or even 30 days. 5 , 7 , 10 , 12 We felt that a rule predicting outcomes within 72 hours of ED assessment might convey a more appropriate assessment of immediate risks that might be mitigated with decisions made in the ED, specifically around the decision to admit at the index visit. The 72‐hour interval is commonly used as a health care quality metric for patient recidivism.…”

Section: Discussionmentioning

confidence: 99%

“… 1 , 2 , 3 , 4 Prior work has identified several clinical factors associated with progression to severe COVID‐19 disease. 5 , 6 , 7 , 8 , 9 , 10 The application of these findings to individual patients to support bedside decision‐making is not intuitive. Clinical decision rules (CDRs) involve the transformation of observed associations between various clinical features and outcomes into a “rule” or score that can be used to risk‐stratify patients and directly support bedside clinical decision‐making with individualized risk estimates.…”

Section: Introductionmentioning

confidence: 99%

“…Most patients who present with COVID‐19 to the emergency department (ED) have no obvious need for admission and are discharged home 1–4 . Prior work has identified several clinical factors associated with progression to severe COVID‐19 disease 5–10 . The application of these findings to individual patients to support bedside decision‐making is not intuitive.…”

Section: Introductionmentioning

confidence: 99%

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Derivation and validation of a clinical decision rule to risk‐stratify COVID‐19 patients discharged from the emergency department: The CCEDRRN COVID discharge score

et al. 2022

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“…A retrospective study during the first three months of the pandemic found that approximately 9% of these patients had another unscheduled ED visit within 72 hours [8]. Similarly, a multicenter study aimed at developing a predictive model for identifying those at risk of a return visit and hospitalization found that 21% of patients had returned to the ED by 30 days from the index ED visit [9]. Unfortunately, the design of these studies precluded the determination of what percentage of repeat visits were related to COVID-19 or what factors may have been responsible for the high rate of return (e.g., worsening symptoms, inadequate follow-up, and anxiety).…”

Section: Introductionmentioning

confidence: 99%

The MedConnect Program: Symptomatology, Return Visits, and Hospitalization of COVID-19 Outpatients Following Discharge From the Emergency Department

Bayly¹,

Kercheval²,

Cranford³

et al. 2022

Cureus

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Background and objectiveAlthough hospitalization is required for only a minority of those infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the high rates of morbidity and mortality among these patients have led researchers to focus on the predictors of admission and adverse outcomes in the inpatient population. However, there is scarce data on the clinical trajectory of individuals symptomatic enough to present for emergency care, but not sick enough to be admitted. In light of this, we aimed to examine the symptomatology, emergency department (ED) revisits, and hospitalization of coronavirus disease 2019 (COVID-19) outpatients after discharge from the ED. MethodsAdult patients with COVID-19 infection were prospectively enrolled after discharge from the ED between May and December 2020. Patients were followed up longitudinally for 14 days via phone interviews designed to provide support and information and to track symptomatology, ED revisits, and hospitalization. ResultsA volunteer, medical student-run program enrolled 199 COVID-19 patients discharged from the ED during the first nine months of the pandemic. Of the 176 patients (88.4%) who completed the 14-day protocol, 29 (16.5%) had a second ED visit and 17 (9.6%) were admitted, 16 (9%) for worsening COVID-19 symptoms. Age, male sex, comorbid illnesses, and self-reported dyspnea, diarrhea, chills, and fever were associated with hospital admission for patients with a subsequent ED visit. For those who did not require admission, symptoms generally improved following ED discharge. Age >65 years and a history of cardiovascular disease (CVD) were associated with a longer duration of cough, but generally, patient characteristics and comorbidities did not significantly affect the overall number or duration of symptoms. ConclusionsNearly one in five patients discharged from the ED with COVID-19 infection had a second ED evaluation during a 14-day follow-up period, despite regular phone interactions aimed at providing support and information. More than half of them required admission for worsening COVID-19 symptoms. Established risk factors for severe disease and self-reported persistence of certain symptoms were associated with hospital admission, while those who did not require hospitalization had a steady improvement in symptoms over the 14-day period.

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Predicting 30‐day return hospital admissions in patients with COVID‐19 discharged from the emergency department: A national retrospective cohort study

Cited by 6 publications

References 26 publications

Early Discharge, Outpatient Evaluation, and Home Management of Acute Respiratory Failure from COVID-19 in Martinique

Early Discharge, Outpatient Evaluation, and Home Management of Acute Respiratory Failure from COVID-19 in Martinique

Derivation and validation of a clinical decision rule to risk‐stratify COVID‐19 patients discharged from the emergency department: The CCEDRRN COVID discharge score

The MedConnect Program: Symptomatology, Return Visits, and Hospitalization of COVID-19 Outpatients Following Discharge From the Emergency Department

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