Epidemiology and clinical features of emergency department patients with suspected and confirmed COVID-19: A multisite report from the COVED Quality Improvement Project for July 2020 (COVED-3)

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Emerg Med Australas. 2020 Sep 21. doi: 10.1111/1742-6723.13651. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to describe the epidemiology and clinical features of patients presenting to the emergency department (ED) with suspected and confirmed COVID-19.

METHODS: The COVID-19 Emergency Department (COVED) Project is an ongoing prospective cohort study in Australian EDs. This analysis presents data from eight sites across Victoria and Tasmania for July 2020 (during Australia’s ‘second wave’). All adult patients who met criteria for ‘suspected COVID-19’ and underwent testing for SARS-CoV-2 in the ED were eligible for inclusion. Study outcomes included a positive SARS-CoV-2 test result and mechanical ventilation.

RESULTS: In the period 1 to 31 July 2020, there were 30 378 presentations to the participating EDs and 2917 (9.6%; 95% CI: 9.3-9.9) underwent testing for SARS-CoV-2. Of these, 50 (2%) patients returned a positive result. Among positive cases, two (4%) received mechanical ventilation during their hospital admission compared to 45 (2%) of the SARS-CoV-2 negative patients (OR 1.7 [95% CI: 0.4-7.3], p = 0.47). Two (4%) SARS-CoV-2 positive patients died in hospital compared to 46 (2%) of the SARS-CoV-2 negative patients (OR 1.7 [0.4-7.1] p = 0.49). Strong clinical predictors of a positive result included self-reported fever, non-smoking status, bilateral infiltrates on CXR, and absence of a leucocytosis on first ED blood tests (p < 0.05).

CONCLUSIONS: In this prospective multi-site study from July 2020, a substantial proportion of ED patients required SARS-CoV-2 testing, isolation and enhanced infection prevention and control precautions. Presence of SARS-CoV-2 on nasopharyngeal swab was not associated with death or mechanical ventilation. This article is protected by copyright. All rights reserved.

PMID:32959497 | DOI:10.1111/1742-6723.13651