Open AccessRisk of readmission to the emergency department in mild COVID-19 outpatients with telehealth follow-up
Author(s) -
Ana Soledad Pedretti,
Santiago Márquez Fosser,
Rosario Pasquinelli,
Marcelo Vallone,
Fernando Plazzotta,
Daniel Luna,
B. Martínez,
P. Suárez-Anta Rodríguez,
María Florencia Grande Ratti
Publication year - 2021
Publication title -
revista de la facultad de ciencias médicas de córdoba
Language(s) - English
Resource type - Journals
eISSN - 1853-0605
pISSN - 0014-6722
DOI - 10.31053/1853.0605.v78.n3.32414
Subject(s) - medicine , emergency department , incidence (geometry) , retrospective cohort study , confounding , telehealth , covid-19 , logistic regression , emergency medicine , cohort , diabetes mellitus , cumulative incidence , pediatrics , telemedicine , health care , physics , disease , psychiatry , infectious disease (medical specialty) , optics , economics , economic growth , endocrinology
To describe patients´ characteristics of confirmed COVID-19 with mild symptoms discharged home from the Emergency Department (ED) and followed using telemedicine, to estimate ED-readmission rates and hospitalization, and to explore associated factors with these clinical outcomes.
Methods: We performed a retrospective cohort study in Hospital Italiano de Buenos Aires from June to August 2020, which included patients with mild COVID-19 symptoms, diagnosed with a positive result. Follow-up occurred from discharged until ED-readmission or 14 days. We estimate cumulative incidence using the Kaplan-Meier model and associated factors using logistic regression.
Results: We included 1,239 patients, with a median of 41 years and 53.82% male. A total of 167 patients were readmitted to the ED within 14 days, with a global incidence rate of 13.08% (95%CI 11.32-15.08). Of these, 83 required hospitalization (median time from diagnosis 4.98 days), 5.98% was not related to any COVID-19 complication, and five patients died. After adjustment by confounders (age ≥65, sex, diabetes, hypertension, former smoking, active smoking, fever, diarrhea, and oxygen saturation), we found significant associations: former smoking (adjusted OR 2.09, 95% CI 1.31-3.34, p0 .002), fever (aOR 1.56, 95% CI 1.07-2.28, p0.002) and oxygen saturation (aOR 0.82, 95% CI 0.71-0.95, p0.009).
Conclusion: The 13% rate of ED-readmission during 14 days of follow-up of mild symptomatic COVID-19 patients initially managed as outpatients with telehealth is highly significant in hospital management, quality performance, and patient safety.