Clinical and imaging characteristics of patients with COVID-19 predicting hospital readmission after emergency department discharge: a single-centre cohort study in Italy. Issue 4 (6th April 2022)

• Record Type: Journal Article
• Authors: Galli, Maria Giulia; Djuric, Olivera; Besutti, Giulia; Ottone, Marta; Amidei, Lucia; Bitton, Lee; Bonilauri, Carlotta; Boracchia, Luca; Campanale, Sergio; Curcio, Vittoria; Lucchesi, Davide Maria Francesco; Mulas, Cesare Salvatore; Santi, Francesca; Ferrari, Anna Maria; Giorgi Rossi, Paolo; Luppi, Francesco
• Other Names: author non-byline.; Costantini Massimo author non-byline.; Grilli Roberto author non-byline.; Marino Massimiliano author non-byline.; Formoso Giulio author non-byline.; Formisano Debora author non-byline.; Rossi Paolo Giorgi author non-byline.; Bedeschi Emanuela author non-byline.; Perilli Cinzia author non-byline.; Rosa Elisabetta La author non-byline.; Bisaccia Eufemia author non-byline.; Venturi Ivano author non-byline.; Vicentini Massimo author non-byline.; Campari Cinzia author non-byline.; Gioia Francesco author non-byline.; Broccoli Serena author non-byline.; Ottone Marta author non-byline.; Pattacini Pierpaolo author non-byline.; Besutti Giulia author non-byline.; Iotti Valentina author non-byline.; Spaggiari Lucia author non-byline.; Mancuso Pamela author non-byline.; Nitrosi Andrea author non-byline.; Foracchia Marco author non-byline.; Colla Rossana author non-byline.; Zerbini Alessandro author non-byline.; Massari Marco author non-byline.; Ferrari Anna Maria author non-byline.; Pinotti Mirco author non-byline.; Facciolongo Nicola author non-byline.; Lattuada Ivana author non-byline.; Trabucco Laura author non-byline.; Pietri Stefano De author non-byline.; Danelli Giorgio Francesco author non-byline.; Albertazzi Laura author non-byline.; Bellesia Enrica author non-byline.; Canovi Simone author non-byline.; Corradini Mattia author non-byline.; Fasano Tommaso author non-byline.; Magnani Elena author non-byline.; Pilia Annalisa author non-byline.; Polese Alessandra author non-byline.; Incerti Silvia Storchi author non-byline.; Zaldini Piera author non-byline.; Bonelli Efrem author non-byline.; Orsola Bonanno author non-byline.; Revelli Matteo author non-byline.; Salvarani Carlo author non-byline.; Pinto Carmine author non-byline.; Venturelli Francesco author non-byline.;
• Is Part Of: BMJ open. Volume 12:Issue 4(2022)
• Publication Date: 2022-04-06
• Subjects: COVID-19 -- computed tomography -- accident & emergency medicine -- epidemiology; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2021-052665
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objective: We aimed at identifying baseline predictive factors for emergency department (ED) readmission, with hospitalisation/death, in patients with COVID-19 previously discharged from the ED. We also developed a disease progression velocity index. Design and setting: Retrospective cohort study of prospectively collected data. The charts of consecutive patients with COVID-19 discharged from the Reggio Emilia (Italy) ED (2 March 2 to 31 March 2020) were retrospectively examined. Clinical, laboratory and CT findings at first ED admission were tested as predictive factors using multivariable logistic models. We divided CT extension by days from symptom onset to build a synthetic velocity index. Participants: 450 patients discharged from the ED with diagnosis of COVID-19. Main outcome measure: ED readmission within 14 days, followed by hospitalisation/death. Results: Of the discharged patients, 84 (18.7%) were readmitted to the ED, 61 (13.6%) were hospitalised and 10 (2.2%) died. Age (OR=1.05; 95% CI 1.03 to 1.08), Charlson Comorbidity Index 3 versus 0 (OR=11.61; 95% CI 1.76 to 76.58), days from symptom onset (OR for 1-day increase=0.81; 95% CI 0.73 to 0.90) and CT extension (OR for 1% increase=1.03; 95% CI 1.01 to 1.06) were associated in a multivariable model for readmission with hospitalisation/death. A 2-day lag velocity index was a strong predictor (OR for unit increase=1.21, 95% CI 1.08 to 1.36); the model including this index resulted in less information loss. Conclusions: A velocity index combining CT extension and days from symptom onset predicts disease progression in patients with COVID-19. For example, a 20% CT extension 3 days after symptom onset has the same risk as does 50% after 10 days.