Treatments, resource utilization, and outcomes of COVID-19 patients presenting to emergency departments across pandemic waves: an observational study by the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN)

  1. Corinne M. Hohl
  2. Rhonda J. Rosychuk
  3. Jeffrey P. Hau
  4. Jake Hayward
  5. Megan Landes
  6. Justin W. Yan
  7. Daniel K. Ting
  8. Michelle Welsford
  9. Patrick M. Archambault
  10. Eric Mercier
  11. Kavish Chandra
  12. Philip Davis
  13. Samuel Vaillancourt
  14. Murdoch Leeies
  15. Serena Small
  16. Laurie J. Morrison
  17. the Canadian COVID-19 Rapid Response Network (CCEDRRN) investigators for the Network of Canadian Emergency Researchers, for the Canadian Critical Care Trials Group

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

Background

Treatment for coronavirus disease 2019 (COVID-19) evolved between pandemic waves. Our objective was to compare treatments, acute care utilization, and outcomes of COVID-19 patients presenting to emergency departments (ED) across pandemic waves.

Methods

This observational study enrolled consecutive eligible COVID-19 patients presenting to 46 EDs participating in the Canadian COVID-19 ED Rapid Response Network (CCEDRRN) between March 1 and December 31, 2020. We collected data by retrospective chart review. Our primary outcome was in-hospital mortality. Secondary outcomes included treatments, hospital and ICU admissions, ED revisits and readmissions. Logistic regression modeling assessed the impact of pandemic wave on outcomes.

Results

We enrolled 9,967 patients in 8 provinces, 3,336 from the first and 6,631 from the second wave. Patients in the second wave were younger, fewer met criteria for severe COVID-19, and more were discharged from the ED. Adjusted for patient characteristics and disease severity, steroid use increased (odds ratio [OR] 7.4; 95% confidence interval [CI] 6.2–8.9), and invasive mechanical ventilation decreased (OR 0.5; 95% CI 0.4–0.7) in the second wave compared to the first. After adjusting for differences in patient characteristics and disease severity, the odds of hospitalization (OR 0.7; 95% CI 0.6–0.8) and critical care admission (OR 0.7; 95% CI 0.6–0.9) decreased, while mortality remained unchanged (OR 0.7; 95% CI 0.5–1.1).

Interpretation

In patients presenting to cute care facilities, we observed rapid uptake of evidence-based therapies and less use of experimental therapies in the second wave. We observed increased rates of ED discharges and lower hospital and critical care resource use over time. Substantial reductions in mechanical ventilation were not associated with increasing mortality. Advances in treatment strategies created health system efficiencies without compromising patient outcomes.

Trial registration

Clinicaltrials.gov, NCT04702945.

Article activity feed

  1. Version published to 10.1007/s43678-022-00275-3
  2. ScreenIT

    SciScore for 10.1101/2021.07.30.21261288: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsConsent: Design and Setting: This pan-Canadian observational study enrolled consecutive eligible COVID-19 patients who presented to the EDs of 46 participating acute care hospitals between March 1 and December 31, 2020.(17) The research ethics boards of participating institutions reviewed and approved the study protocol with a waiver of informed consent for patient enrollment.
    Sex as a biological variableWe conducted subgroup analyses on patients with severe COVID, pregnant patients, those reporting unstable housing, and those requiring invasive mechanical ventilation.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    We conducted all analyses using Stata (Version 16.1, StataCorp, College Station, Texas).
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    NCT04702945RecruitingCanadian COVID-19 Emergency Department Registry

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.07.30.21261288v1 on medRxiv