Universität zu Köln

Moeckel, Martin, Stegemann, Miriam Songa, Burst, Volker, Kuempers, Philipp, Risse, Joachim, Koehler, Felix Carlo ORCID: 0000-0001-9269-7420, Schunk, Domagoj, Hitzek, Jennifer, Dietrich, Tamara Elene and Slagman, Anna (2021). Which parameters support disposition decision in suspected COVID-19 cases in the emergency department (ED): a German clinical cohort study. BMJ Open, 11 (3). LONDON: BMJ PUBLISHING GROUP. ISSN 2044-6055

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Abstract

Objectives One major goal of the emergency department (ED) is to decide, whether patients need to be hospitalised or can be sent home safely. We aim at providing criteria for these decisions without knowing the SARS-CoV-2 test result in suspected cases. Setting Tertiary emergency medicine. Participants All patients were treated at the ED of the Charite during the pandemic peak and underwent SARS-CoV-2 testing. Patients with positive test results were characterised in detail and underwent a 14-day-follow-up. Primary and secondary outcome measures Logistic regression and classification and regression tree (CART) analyses were performed to identify predictors (primary endpoint), which confirm safe discharge. The clinical endpoint was all-cause mortality or need for mechanical ventilation during index stay or after readmission. Results The primary test population of suspected COVID-19 consisted of n=1255 cases, 45.2% were women (n=567). Of these, n=110 tested positive for SARS-CoV-2 (8.8%). The median age of SARS-CoV-2-positive cases was 45 years (IQR: 33-66 years), whereas the median age of the group tested negative for SARS-CoV-2 was 42 years (IQR: 30-60 years) (p=0.096). 43.6% were directly admitted to hospital care. CART analysis identified the variables oxygen saturation (<95%), dyspnoea and history of cardiovascular (CV) disease to distinguish between high and low-risk groups. If all three variables were negative, most patients were discharged from ED, and the incidence of the clinical endpoint was 0%. The validation cohort confirmed the safety of discharge using these variables and revealed an incidence of the clinical endpoint from 14.3% in patients with CV disease, 9.4% in patients with dyspnoea and 18.2% in patients with O-2 satuaration below 95%. Conclusions Based on easily available variables like dyspnoea, oxygen saturation, history of CV disease, approximately 25% of patients subsequently confirmed with COVID-19 can be identified for safe discharge.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Moeckel, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Stegemann, Miriam Songa UNSPECIFIED UNSPECIFIED UNSPECIFIED Burst, Volker UNSPECIFIED UNSPECIFIED UNSPECIFIED Kuempers, Philipp UNSPECIFIED UNSPECIFIED UNSPECIFIED Risse, Joachim UNSPECIFIED UNSPECIFIED UNSPECIFIED Koehler, Felix Carlo UNSPECIFIED orcid.org/0000-0001-9269-7420 UNSPECIFIED Schunk, Domagoj UNSPECIFIED UNSPECIFIED UNSPECIFIED Hitzek, Jennifer UNSPECIFIED UNSPECIFIED UNSPECIFIED Dietrich, Tamara Elene UNSPECIFIED UNSPECIFIED UNSPECIFIED Slagman, Anna UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-593243
DOI:	10.1136/bmjopen-2020-044853
Journal or Publication Title:	BMJ Open
Volume:	11
Number:	3
Date:	2021
Publisher:	BMJ PUBLISHING GROUP
Place of Publication:	LONDON
ISSN:	2044-6055
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language Medicine, General & Internal Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/59324