A safe protocol to identify low-risk patients with COVID-19 pneumonia for outpatient management.

Autor: Teigell Muñoz FJ; Department of Emergency Medicine and Internal Medicine, Infanta Cristina University Hospital, Madrid, Spain. javier.teigell@gmail.com.; Department of Medicine, Complutense University, Madrid, Spain. javier.teigell@gmail.com., García-Guijarro E; Department of Emergency Medicine and Internal Medicine, Infanta Cristina University Hospital, Madrid, Spain.; Department of Medicine, Complutense University, Madrid, Spain., García-Domingo P; Department of Emergency Medicine and Internal Medicine, Infanta Cristina University Hospital, Madrid, Spain.; Department of Medicine, Complutense University, Madrid, Spain., Pérez-Nieto G; Department of Emergency Medicine and Internal Medicine, Infanta Cristina University Hospital, Madrid, Spain.; Department of Medicine, Complutense University, Madrid, Spain., Roque Rojas F; Department of Emergency Medicine and Internal Medicine, Infanta Cristina University Hospital, Madrid, Spain.; Department of Medicine, Complutense University, Madrid, Spain., García-Peña M; Department of Pathology, Infanta Cristina University Hospital, Madrid, Spain., Nieto Gallo MA; Department of Pathology, Infanta Cristina University Hospital, Madrid, Spain., Melero Bermejo JA; Department of Emergency Medicine and Internal Medicine, Infanta Cristina University Hospital, Madrid, Spain.; Department of Medicine, Complutense University, Madrid, Spain., de Guzman García-Monge MT; Department of Emergency Medicine and Internal Medicine, Infanta Cristina University Hospital, Madrid, Spain.; Department of Medicine, Complutense University, Madrid, Spain., Granizo JJ; Preventive Medicine Unit, Infanta Cristina University Hospital, Madrid, Spain.; Institute of Investigations Puerta de Hierro-Segovia de Arana, Madrid, Spain.
Jazyk: angličtina
Zdroj: Internal and emergency medicine [Intern Emerg Med] 2021 Sep; Vol. 16 (6), pp. 1663-1671. Date of Electronic Publication: 2021 Feb 23.
DOI: 10.1007/s11739-021-02660-9
Abstrakt: The coronavirus disease 2019 (COVID-19) outbreak has made it necessary to rationalize health-care resources, but there is little published data at this moment regarding ambulatory management of patients with COVID-19 pneumonia. The objective of the study is to evaluate the performance of a protocol for ambulatory management of patients with COVID-19 pneumonia regarding readmissions, admission into the Intensive Care Unit (ICU) and deaths. Also, to identify unfavorable prognostic factors that increase the risk of readmission. This is a prospective cohort study of patients with COVID-19 pneumonia discharged from the emergency ward of Infanta Cristina Hospital (Madrid, Spain) that met the criteria of the hospital protocol for outpatient management. We describe outcomes of those patients and compare those who needed readmission versus those who did not. We use logistic regression to explore factors associated with readmissions. A total of 314 patients were included, of which 20 (6.4%) needed readmission, and none needed ICU admission nor died. At least one comorbidity was present in 29.9% of patients. Hypertension, leukopenia, lymphocytopenia, increased lactate dehydrogenase (LDH) and increased aminotransferases were all associated with a higher risk of readmission. A clinical course of 10 days or longer, and an absolute eosinophil count over 200/µL were associated with a lower risk. After the multivariate analysis, only hypertension (OR 4.99, CI 1.54-16.02), temperature over 38 °C in the emergency ward (OR 9.03, CI 1.89-45.77), leukopenia (OR 4.92, CI 1.42-17.11) and increased LDH (OR 6.62, CI 2.82-19.26) remained significantly associated with readmission. Outpatient management of patients with low-risk COVID-19 pneumonia is safe, if adequately selected. The protocol presented here has allowed avoiding 30% of the admissions for COVID-19 pneumonia in our hospital, with a very low readmission rate and no mortality.
(© 2021. Società Italiana di Medicina Interna (SIMI).)
Databáze: MEDLINE
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