Clinical and imaging characteristics of patients with COVID-19 predicting hospital readmission after emergency department discharge : a single-centre cohort study in Italy
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ..
OBJECTIVE: We aimed at identifying baseline predictive factors for emergency department (ED) readmission, with hospitalisation/death, in patients with COVID-19 previously discharged from the ED. We also developed a disease progression velocity index.
DESIGN AND SETTING: Retrospective cohort study of prospectively collected data. The charts of consecutive patients with COVID-19 discharged from the Reggio Emilia (Italy) ED (2 March 2 to 31 March 2020) were retrospectively examined. Clinical, laboratory and CT findings at first ED admission were tested as predictive factors using multivariable logistic models. We divided CT extension by days from symptom onset to build a synthetic velocity index.
PARTICIPANTS: 450 patients discharged from the ED with diagnosis of COVID-19.
MAIN OUTCOME MEASURE: ED readmission within 14 days, followed by hospitalisation/death.
RESULTS: Of the discharged patients, 84 (18.7%) were readmitted to the ED, 61 (13.6%) were hospitalised and 10 (2.2%) died. Age (OR=1.05; 95% CI 1.03 to 1.08), Charlson Comorbidity Index 3 versus 0 (OR=11.61; 95% CI 1.76 to 76.58), days from symptom onset (OR for 1-day increase=0.81; 95% CI 0.73 to 0.90) and CT extension (OR for 1% increase=1.03; 95% CI 1.01 to 1.06) were associated in a multivariable model for readmission with hospitalisation/death. A 2-day lag velocity index was a strong predictor (OR for unit increase=1.21, 95% CI 1.08 to 1.36); the model including this index resulted in less information loss.
CONCLUSIONS: A velocity index combining CT extension and days from symptom onset predicts disease progression in patients with COVID-19. For example, a 20% CT extension 3 days after symptom onset has the same risk as does 50% after 10 days.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:12 |
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| Enthalten in: |
BMJ open - 12(2022), 4 vom: 06. Apr., Seite e052665 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Galli, Maria Giulia [VerfasserIn] |
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| Links: |
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| Themen: |
Accident & emergency medicine |
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| Anmerkungen: |
Date Completed 08.04.2022 Date Revised 25.05.2022 published: Electronic Citation Status MEDLINE |
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| doi: |
10.1136/bmjopen-2021-052665 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM339175451 |
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| 100 | 1 | |a Galli, Maria Giulia |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Clinical and imaging characteristics of patients with COVID-19 predicting hospital readmission after emergency department discharge |b a single-centre cohort study in Italy |
| 264 | 1 | |c 2022 | |
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| 500 | |a Date Completed 08.04.2022 | ||
| 500 | |a Date Revised 25.05.2022 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. | ||
| 520 | |a OBJECTIVE: We aimed at identifying baseline predictive factors for emergency department (ED) readmission, with hospitalisation/death, in patients with COVID-19 previously discharged from the ED. We also developed a disease progression velocity index | ||
| 520 | |a DESIGN AND SETTING: Retrospective cohort study of prospectively collected data. The charts of consecutive patients with COVID-19 discharged from the Reggio Emilia (Italy) ED (2 March 2 to 31 March 2020) were retrospectively examined. Clinical, laboratory and CT findings at first ED admission were tested as predictive factors using multivariable logistic models. We divided CT extension by days from symptom onset to build a synthetic velocity index | ||
| 520 | |a PARTICIPANTS: 450 patients discharged from the ED with diagnosis of COVID-19 | ||
| 520 | |a MAIN OUTCOME MEASURE: ED readmission within 14 days, followed by hospitalisation/death | ||
| 520 | |a RESULTS: Of the discharged patients, 84 (18.7%) were readmitted to the ED, 61 (13.6%) were hospitalised and 10 (2.2%) died. Age (OR=1.05; 95% CI 1.03 to 1.08), Charlson Comorbidity Index 3 versus 0 (OR=11.61; 95% CI 1.76 to 76.58), days from symptom onset (OR for 1-day increase=0.81; 95% CI 0.73 to 0.90) and CT extension (OR for 1% increase=1.03; 95% CI 1.01 to 1.06) were associated in a multivariable model for readmission with hospitalisation/death. A 2-day lag velocity index was a strong predictor (OR for unit increase=1.21, 95% CI 1.08 to 1.36); the model including this index resulted in less information loss | ||
| 520 | |a CONCLUSIONS: A velocity index combining CT extension and days from symptom onset predicts disease progression in patients with COVID-19. For example, a 20% CT extension 3 days after symptom onset has the same risk as does 50% after 10 days | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a accident & emergency medicine | |
| 650 | 4 | |a computed tomography | |
| 650 | 4 | |a epidemiology | |
| 700 | 1 | |a Djuric, Olivera |e verfasserin |4 aut | |
| 700 | 1 | |a Besutti, Giulia |e verfasserin |4 aut | |
| 700 | 1 | |a Ottone, Marta |e verfasserin |4 aut | |
| 700 | 1 | |a Amidei, Lucia |e verfasserin |4 aut | |
| 700 | 1 | |a Bitton, Lee |e verfasserin |4 aut | |
| 700 | 1 | |a Bonilauri, Carlotta |e verfasserin |4 aut | |
| 700 | 1 | |a Boracchia, Luca |e verfasserin |4 aut | |
| 700 | 1 | |a Campanale, Sergio |e verfasserin |4 aut | |
| 700 | 1 | |a Curcio, Vittoria |e verfasserin |4 aut | |
| 700 | 1 | |a Lucchesi, Davide Maria Francesco |e verfasserin |4 aut | |
| 700 | 1 | |a Mulas, Cesare Salvatore |e verfasserin |4 aut | |
| 700 | 1 | |a Santi, Francesca |e verfasserin |4 aut | |
| 700 | 1 | |a Ferrari, Anna Maria |e verfasserin |4 aut | |
| 700 | 1 | |a Giorgi Rossi, Paolo |e verfasserin |4 aut | |
| 700 | 1 | |a Luppi, Francesco |e verfasserin |4 aut | |
| 700 | 0 | |a Reggio Emilia COVID-19 Working Group |e verfasserin |4 aut | |
| 700 | 1 | |a Costantini, Massimo |e investigator |4 oth | |
| 700 | 1 | |a Grilli, Roberto |e investigator |4 oth | |
| 700 | 1 | |a Marino, Massimiliano |e investigator |4 oth | |
| 700 | 1 | |a Formoso, Giulio |e investigator |4 oth | |
| 700 | 1 | |a Formisano, Debora |e investigator |4 oth | |
| 700 | 1 | |a Rossi, Paolo Giorgi |e investigator |4 oth | |
| 700 | 1 | |a Bedeschi, Emanuela |e investigator |4 oth | |
| 700 | 1 | |a Perilli, Cinzia |e investigator |4 oth | |
| 700 | 1 | |a Rosa, Elisabetta La |e investigator |4 oth | |
| 700 | 1 | |a Bisaccia, Eufemia |e investigator |4 oth | |
| 700 | 1 | |a Venturi, Ivano |e investigator |4 oth | |
| 700 | 1 | |a Vicentini, Massimo |e investigator |4 oth | |
| 700 | 1 | |a Campari, Cinzia |e investigator |4 oth | |
| 700 | 1 | |a Gioia, Francesco |e investigator |4 oth | |
| 700 | 1 | |a Broccoli, Serena |e investigator |4 oth | |
| 700 | 1 | |a Ottone, Marta |e investigator |4 oth | |
| 700 | 1 | |a Pattacini, Pierpaolo |e investigator |4 oth | |
| 700 | 1 | |a Besutti, Giulia |e investigator |4 oth | |
| 700 | 1 | |a Iotti, Valentina |e investigator |4 oth | |
| 700 | 1 | |a Spaggiari, Lucia |e investigator |4 oth | |
| 700 | 1 | |a Mancuso, Pamela |e investigator |4 oth | |
| 700 | 1 | |a Nitrosi, Andrea |e investigator |4 oth | |
| 700 | 1 | |a Foracchia, Marco |e investigator |4 oth | |
| 700 | 1 | |a Colla, Rossana |e investigator |4 oth | |
| 700 | 1 | |a Zerbini, Alessandro |e investigator |4 oth | |
| 700 | 1 | |a Massari, Marco |e investigator |4 oth | |
| 700 | 1 | |a Ferrari, Anna Maria |e investigator |4 oth | |
| 700 | 1 | |a Pinotti, Mirco |e investigator |4 oth | |
| 700 | 1 | |a Facciolongo, Nicola |e investigator |4 oth | |
| 700 | 1 | |a Lattuada, Ivana |e investigator |4 oth | |
| 700 | 1 | |a Trabucco, Laura |e investigator |4 oth | |
| 700 | 1 | |a Pietri, Stefano De |e investigator |4 oth | |
| 700 | 1 | |a Danelli, Giorgio Francesco |e investigator |4 oth | |
| 700 | 1 | |a Albertazzi, Laura |e investigator |4 oth | |
| 700 | 1 | |a Bellesia, Enrica |e investigator |4 oth | |
| 700 | 1 | |a Canovi, Simone |e investigator |4 oth | |
| 700 | 1 | |a Corradini, Mattia |e investigator |4 oth | |
| 700 | 1 | |a Fasano, Tommaso |e investigator |4 oth | |
| 700 | 1 | |a Magnani, Elena |e investigator |4 oth | |
| 700 | 1 | |a Pilia, Annalisa |e investigator |4 oth | |
| 700 | 1 | |a Polese, Alessandra |e investigator |4 oth | |
| 700 | 1 | |a Incerti, Silvia Storchi |e investigator |4 oth | |
| 700 | 1 | |a Zaldini, Piera |e investigator |4 oth | |
| 700 | 1 | |a Bonelli, Efrem |e investigator |4 oth | |
| 700 | 1 | |a Orsola, Bonanno |e investigator |4 oth | |
| 700 | 1 | |a Revelli, Matteo |e investigator |4 oth | |
| 700 | 1 | |a Salvarani, Carlo |e investigator |4 oth | |
| 700 | 1 | |a Pinto, Carmine |e investigator |4 oth | |
| 700 | 1 | |a Venturelli, Francesco |e investigator |4 oth | |
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