Comparison of outcomes in emergency department revisiting patients before and after coronavirus disease 2019 epidemic. (27th May 2022)

• Record Type: Journal Article
• Authors: Chen, Chung-Ting; Wang, Tse-Yao; Shih, Chia-Hui; Yen, David Hung-Tsang; Tung, Yu-Chi
• Is Part Of: European journal of emergency medicine. Volume 29:Number 5(2022)
• Page Start: 373
• Page End: 379
• Publication Date: 2022-05-27
• Subjects: COVID-19 -- emergency department revisit -- epidemic -- healthcare quality -- metrics -- quality measure; Emergency medicine -- Europe -- Periodicals; Medical emergencies -- Europe -- Periodicals; Emergency medical services -- Europe -- Periodicals; Emergencies -- Europe -- Periodicals; Emergency Medical Services -- Europe -- Periodicals; Emergency Medicine -- Europe -- periodicals; 616.025
• DOI: 10.1097/MEJ.0000000000000946
• Languages: English
• ISSNs: 0969-9546

Abstract

Abstract : Background and importance: The outbreak of COVID-19 challenged the global health system and specifically impacted the emergency departments (EDs). Studying the quality indicators of ED care under COVID-19 has been a necessary task, and ED revisits have been used as an indicator to monitor ED performance. Objectives: The study investigated whether discrepancies existed among ED revisiting cases before and after COVID-19 and whether the COVID-19 epidemic was a predictor of poor outcomes of ED revisits. Design: Retrospective study. Settings and participants: We used electronic health records data from a tertiary medical center. Data of patients with 72-h ED revisit after the COVID-19 epidemic were collected from February 2020 to June 2020 and compared with those of patients before COVID-19, from February 2019 to June 2019. Outcome measures and analysis: The investigated outcomes included hospital admission, ICU admission, out-of-hospital cardiac arrest, and subsequent inhospital mortality. Univariate and multivariate logistic regression models were used to identify independent predictors of 72-h ED revisit outcomes. Main results: In total, 1786 patients were enrolled in our study – 765 in the COVID group and 1021 in the non-COVID group. Compared with the non-COVID group, patients in the COVID group were younger (53.9 vs. 56.1 years old; P = 0.002) and more often female (66.1% vs. 47.3%; P < 0.001) and had less escalation of triage level (11.6% vs. 15.0%; P = 0.041). The hospital admission and inhospital mortality rates in the COVID and non-COVID groups were 33.9% vs. 32.0% and 2.7% vs. 1.5%, respectively. In the logistic regression model, the COVID-19 period was significantly associated with inhospital mortality (adjusted odds ratio, 2.289; 95% confidence interval, 1.059–4.948; P = 0.035). Conclusion: Patients with 72-h ED revisits showed distinct demographic and clinical patterns before and after the COVID-19 epidemic; the COVID-19 period was an independent predictor of increased inhospital mortality.