A safe protocol to identify low risk patients with COVID-19 pneumonia for outpatient management

  1. Francisco Javier Teigell Muñoz
  2. Elena García-Guijarro
  3. Paula García-Domingo
  4. Guadalupe Pérez-Nieto
  5. Fernando Roque Rojas
  6. María García-Peña
  7. María Antonia Nieto Gallo
  8. Jose Antonio Melero Bermejo
  9. Maria Teresa de Guzman García-Monge
  10. Juan José Granizo

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Abstract

Background

The 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.

Objective

Evaluate 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.

Methods

Prospective 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.

Findings

314 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.

Conclusion

Outpatient 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.

Funding

The authors received no specific funding for this work.

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    SciScore for 10.1101/2020.12.15.20229286: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analysis: IBM SPSS 16.0 was used for analysis.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    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: No clinical trial numbers were referenced.

    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.

    About SciScore

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  2. Version published to 10.1101/2020.12.15.20229286v1 on medRxiv