tetano
Editor, Senior Moderator
Ann Emerg Med
. 2022 Nov 2;S0196-0644(22)01037-X.
doi: 10.1016/j.annemergmed.2022.08.449. Online ahead of print.
Characteristics and Outcomes of 360 Consecutive COVID-19 Patients Discharged from the Emergency Department with Supplemental Oxygen
Sophie Terp[SUP] 1 [/SUP], Zach Reichert[SUP] 2 [/SUP], Elizabeth Burner[SUP] 3 [/SUP], Jasmeen Randhawa[SUP] 3 [/SUP], Sarah Axeen[SUP] 4 [/SUP], Michael Messina[SUP] 2 [/SUP], Daniel A Dworkis[SUP] 3 [/SUP], Michael Menchine[SUP] 3 [/SUP], Chun Nok Lam[SUP] 3 [/SUP], Josh Banerjee[SUP] 2 [/SUP], Brad Spellberg[SUP] 2 [/SUP], Sanjay Arora[SUP] 3 [/SUP]
Affiliations
Abstract
Study objective: To describe characteristics and outcomes of coronavirus disease (COVID-19) patients with new supplemental oxygen requirements discharged from a large public urban emergency department (ED) with supplemental oxygen.
Methods: This observational case series describes the characteristics and outcomes of 360 consecutive COVID-19 patients with new supplemental oxygen requirements discharged from a large urban public ED between April 2020 and March 2021 with supplemental oxygen. Primary outcomes included 30-day survival and 30-day survival without unscheduled inpatient admission. Demographic and clinical data were collected through a structured chart review.
Results: Among 360 patients with COVID-19 discharged from the ED with supplemental oxygen, 30-day survival was 97.5% (95% confidence interval (CI) 95.3 to 98.9%; n=351), and 30-day survival without unscheduled admission was 81.1% (95% CI 76.7 to 85.0%; n=292). A sensitivity analysis incorporating worst-case-scenario for 12 patients without complete follow-up 30 days after index visit yields 30-day survival of 95.5% (95% CI 92.5 to 97.2%; n=343), and 30-day survival without unscheduled admission of 78.9% (95% CI 74.3 to 83.0%; n=284). Among study patients, 32.2% (n=116) had a nadir ED oxygen saturation of <90%, among these 30-day survival was 97.4% (95% CI 92.6 to 99.4%; n=113), and 30-day survival without unscheduled admission was 76.7% (95% CI 68.8 to 84.1%; n=89).
Conclusion: COVID-19 patients with new supplemental oxygen requirements discharged from the ED had survival comparable to COVID-19 ED patients with mild exertional hypoxia treated with supplemental oxygen in other settings, and this held true when the analysis was restricted to patients with nadir ED index visit oxygen saturations <90%. Discharge of select COVID-19 patients with supplemental oxygen from the ED may provide a viable alternative to hospitalization, particularly when inpatient capacity is limited.
. 2022 Nov 2;S0196-0644(22)01037-X.
doi: 10.1016/j.annemergmed.2022.08.449. Online ahead of print.
Characteristics and Outcomes of 360 Consecutive COVID-19 Patients Discharged from the Emergency Department with Supplemental Oxygen
Sophie Terp[SUP] 1 [/SUP], Zach Reichert[SUP] 2 [/SUP], Elizabeth Burner[SUP] 3 [/SUP], Jasmeen Randhawa[SUP] 3 [/SUP], Sarah Axeen[SUP] 4 [/SUP], Michael Messina[SUP] 2 [/SUP], Daniel A Dworkis[SUP] 3 [/SUP], Michael Menchine[SUP] 3 [/SUP], Chun Nok Lam[SUP] 3 [/SUP], Josh Banerjee[SUP] 2 [/SUP], Brad Spellberg[SUP] 2 [/SUP], Sanjay Arora[SUP] 3 [/SUP]
Affiliations
- PMID: 36334954
- DOI: 10.1016/j.annemergmed.2022.08.449
Abstract
Study objective: To describe characteristics and outcomes of coronavirus disease (COVID-19) patients with new supplemental oxygen requirements discharged from a large public urban emergency department (ED) with supplemental oxygen.
Methods: This observational case series describes the characteristics and outcomes of 360 consecutive COVID-19 patients with new supplemental oxygen requirements discharged from a large urban public ED between April 2020 and March 2021 with supplemental oxygen. Primary outcomes included 30-day survival and 30-day survival without unscheduled inpatient admission. Demographic and clinical data were collected through a structured chart review.
Results: Among 360 patients with COVID-19 discharged from the ED with supplemental oxygen, 30-day survival was 97.5% (95% confidence interval (CI) 95.3 to 98.9%; n=351), and 30-day survival without unscheduled admission was 81.1% (95% CI 76.7 to 85.0%; n=292). A sensitivity analysis incorporating worst-case-scenario for 12 patients without complete follow-up 30 days after index visit yields 30-day survival of 95.5% (95% CI 92.5 to 97.2%; n=343), and 30-day survival without unscheduled admission of 78.9% (95% CI 74.3 to 83.0%; n=284). Among study patients, 32.2% (n=116) had a nadir ED oxygen saturation of <90%, among these 30-day survival was 97.4% (95% CI 92.6 to 99.4%; n=113), and 30-day survival without unscheduled admission was 76.7% (95% CI 68.8 to 84.1%; n=89).
Conclusion: COVID-19 patients with new supplemental oxygen requirements discharged from the ED had survival comparable to COVID-19 ED patients with mild exertional hypoxia treated with supplemental oxygen in other settings, and this held true when the analysis was restricted to patients with nadir ED index visit oxygen saturations <90%. Discharge of select COVID-19 patients with supplemental oxygen from the ED may provide a viable alternative to hospitalization, particularly when inpatient capacity is limited.