A safe protocol to identify low-risk patients with COVID-19 pneumonia for outpatient management
| Autor: | Paula García-Domingo, María García-Peña, Francisco Muñoz, María Antonia Nieto Gallo, Maria Teresa de Guzman García-Monge, Fernando Roque Rojas, Jose Antonio Melero Bermejo, Elena García-Guijarro, Juan José Granizo, Guadalupe Pérez-Nieto |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
medicine.medical_specialty Multivariate analysis Critical Care Clinical Decision-Making EM - Original 030204 cardiovascular system & hematology Lower risk Severity of Illness Index law.invention 03 medical and health sciences 0302 clinical medicine Risk Factors law Outpatients Ambulatory Care Internal Medicine Humans Medicine COVID-19 pneumonia Prospective Studies 030212 general & internal medicine Prospective cohort study Aged Low risk COVID-19 pneumonia Leukopenia SARS-CoV-2 business.industry Outpatient management COVID-19 Middle Aged medicine.disease Intensive care unit Comorbidity Intensive Care Units Pneumonia Respiratory failure Spain Emergency medicine Ambulatory Emergency Medicine medicine.symptom business |
| Zdroj: | Internal and Emergency Medicine |
| ISSN: | 1970-9366 1828-0447 |
| DOI: | 10.1007/s11739-021-02660-9 |
| Popis: | BackgroundThe coronavirus disease 2019 (COVID-19) outbreak has made necessary to rationalize health-care resources, but there are no published data to this moment regarding ambulatory management of patients with COVID-19 pneumonia.ObjectiveEvaluate the results of a protocol for ambulatory management of patients with COVID-19 pneumonia according to the rate of readmissions, admission into the Intensive Care Unit (ICU) and deaths. Identify unfavorable prognostic factors that increase the risk of readmission, ICU admission and/or death.MethodsProspective 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 we did not. We use logistic regression to explore factors associated with readmissions.Findings314 patients were included, of which 20 (6.4%) needed readmission, 3 (1%) developed severe respiratory failure, and none needed ICU admission nor died. 29.9% of patients had any one comorbidity. Hypertension, leukopenia, lymphocytopenia, increased lactate dehydrogenase (LDH), increased aminotransferases were associated to 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 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 to readmission.ConclusionOutpatient 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 non-existing mortality.FundingThe authors received no specific funding for this work. |
| Databáze: | OpenAIRE |
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