Emergency department characteristics and associations with intensive care admission among patients with coronavirus disease 2019

Objective: There have been few descriptions in the literature to date specifically examining initial coronavirus disease 2019 (COVID-19) patient presentation to the emergency department (ED) and the trajectory of patients who develop critical illness. Here we describe the ED presentation and outcomes of patients with COVID-19 presenting during our initial local surge.

Methods: This is a multicenter, retrospective cohort study using data extracted from the electronic health records at 3 hospitals within a single health system from March 1, 2020 to June 1, 2020. Patients were included in the study if they presented to an ED and had laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during the study period. Data elements were extracted from the electronic health record electronically and by trained data abstractors and entered into a secure database. We used multivariable regression analysis to examine ED factors associated with the development of critical illness and mortality, with a primary outcome of ICU admission.

Results: A total of 330 patients with laboratory-confirmed SARS-CoV-2 infection were admitted during the study period. Of these, 112 (34%) were admitted to the ICU. Among these patients, 20% were female, 50% were White, the median age was 61 (interquartile range [IQR], 52-72), and the median body mass index (BMI) was 28.1 (IQR, 24.3-35.1). On univariable analysis, a doubling of lactate dehydrogenase (LDH) (odds ratio [OR], 3.87; 95% confidence interval [CI], 2.40-6.27) or high-sensitivity C-reactive protein (hsCRP; OR, 1.32; 95% CI, 1.11-1.57) above the reference range or elevated troponin (OR, 12.1; 95% CI, 1.20-121.8) were associated with ICU admission. After adjusting for age, sex, and BMI, LDH was the best predictor of ICU admission (OR, 3.54; 95% CI, 2.12-5.90). Of the patients, 15% required invasive mechanical ventilation during their hospital course, and in-hospital mortality was 19%.

Conclusions: Nearly one-third of ED patients who required hospitalization for COVID-19 were admitted to the ICU, 15% received invasive mechanical ventilation, and 19% died. Most patients who were admitted from the ED were tachypneic with elevated inflammatory markers, and the following factors were associated with ICU admission: elevated hsCRP, LDH, and troponin as well as lower oxygen saturation and increased respiratory rate.