Factors associated with clinical severity in Emergency Department patients presenting with symptomatic SARS-CoV-2 infection
Autor: | Andrew C. Meltzer, Seamus Moran, Jincong Q. Freeman, Joanna S. Cohen, Robert Shesser, Benjamin Zollinger, Yan Ma, Kayla Authelet, Sophia Newton, Nataly Montano Vargas, Matthew McHarg, Derek A. T. Cummings, Alexandra Helfand |
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Rok vydání: | 2020 |
Předmět: |
medicine.medical_specialty
COVID‐19 disease Infectious Disease socioeconomic factors Logistic regression infectious diseases Article law.invention law emergency medicine Internal medicine Diabetes mellitus Medicine Socioeconomic status Original Research business.industry RC86-88.9 Medical emergencies. Critical care. Intensive care. First aid Emergency department Odds ratio medicine.disease Intensive care unit SARS‐CoV‐2 infection Confidence interval Heart failure Emergency medicine business Medicaid Cohort study |
Zdroj: | Journal of the American College of Emergency Physicians Open Journal of the American College of Emergency Physicians Open, Vol 2, Iss 4, Pp n/a-n/a (2021) medRxiv |
Popis: | Objective To measure the association of race, ethnicity, comorbidities, and insurance status with need for hospitalization of symptomatic emergency department patients with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. Methods This study is a cohort study of symptomatic patients presenting to a single emergency department (ED) with laboratory‐confirmed SARS‐CoV‐2 infection from March 7‐August 9, 2020. We collected patient‐level information regarding demographics, insurance status, comorbidities, level of care, and mortality using a structured chart review. We compared characteristics of patients categorized by (1) home discharge, (2) general hospital ward admission, and (3) intensive care unit (ICU) admission or death within 30 days of the index visit. Univariate and multivariable logistic regression analyses were performed to report odds ratios (OR) and 95% confidence intervals (95% CI) between hospital admission versus ED discharge home and between ICU care versus general hospital ward admission. Results In total, 994 patients who presented to the ED with symptoms were included in the analysis with 551 (55.4%) patients discharged home, 314 (31.6%) patients admitted to the general hospital ward, and 129 (13.0%) admitted to the ICU or dying. Patients requiring admission were more likely to be Black or to have public insurance (Medicaid and/or Medicare). Patients who were admitted to the ICU or dying were more likely aged ≥ 65 years or male. In multivariable logistic regression, old age, public insurance, diabetes, hypertension, obesity, heart failure, and hyperlipidemia were independent predictors of hospital admission. When comparing those who needed ICU care versus general hospital ward admission in univariate logistic regression, patients with Medicaid (OR 2.4, 95% CI 1.2–4.6), Medicare (OR 4.2, 95% CI 2.1–8.4), Medicaid and Medicare (OR 4.3, 95% CI 2.4–7.7), history of chronic obstructive pulmonary disease (OR 2.2, 95% CI 1.2–4.2), hypertension (OR 1.7, 95% CI 1.1–2.7), and heart failure (OR 2.6, 95% CI 1.4–4.7) were more likely to be admitted into the ICU or die; Black (OR 1.1, 95% CI 0.4–2.9) and Hispanic/Latino (OR 1.0, 95% CI 0.6–1.8) patients were less likely to be admitted into the ICU; however, the associations were not statistically significant. In multivariable logistic regression, old age, male sex, public insurance, and heart failure were independent predictors of ICU care/death. Conclusion Comorbidities and public insurance are predictors of more severe illness for patients with SARS‐CoV‐2. This study suggests that the disparities in severity seen in COVID‐19 among Black patients may be attributable, in part, to low socioeconomic status and chronic health conditions. |
Databáze: | OpenAIRE |
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