Characteristics and Outcomes of 360 Consecutive COVID-19 Patients Discharged From the Emergency Department With Supplemental Oxygen - 19/12/22
, Zach Reichert, MD c, Elizabeth Burner, MD, MPH, MSci a, Jasmeen Randhawa, BA a, Sarah Axeen, PhD a, b, Michael Messina, DO c, Daniel A. Dworkis, MD, PhD a, Michael Menchine, MD, MPH a, Chun Nok Lam, PhD, MPH a, Josh Banerjee, MD c, Brad Spellberg, MD c, Sanjay Arora, MD a
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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.
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| Supervising editor: Nicholas M. Mohr, MD, MS |
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| Author contributions: ST, ZR, SA, and JB formulated the study concept and design. All authors ST, ZR, EB, JR, SA, MM, DD, MM, CNL, JB, BS, and SA contributed to the data acquisition. ST and ZR were primarily responsible for data interpretation and drafting of the manuscript. All authors ST, ZR, EB, JR, SA, MM, DD, MM, CNL, JB, BS, and SA contributed substantially to the manuscript revision. ST takes responsibility for the paper as a whole. |
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| Authorship: All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. |
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| Presented the preliminary data from this project at the Western Regional Society for Academic Emergency Medicine Conference on April 1st, 2022, in Stanford, CA, and at the Society for Academic Emergency Medicine Conference on May 12th, 2022, in New Orleans, LA. |
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| A podcast for this article is available at www.annemergmed.com. |
Vol 81 - N° 1
P. 14-19 - janvier 2023 Retour au numéro
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