Evaluation of triage checklist for mild COVID-19 outpatients in predicting subsequent emergency department visits and hospitalization during isolation period
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Abstract
Background and objective
Limited evidence exists regarding the outcomes of patients with coronavirus disease 2019 (COVID-19) who are not hospitalized. This study aimed to assess the outcomes for mild COVID-19 patients in terms of emergency department (ED) visits and hospital admission given initial outpatient triage evaluation and to identify the triage factors affecting these outcomes.
Methods
This retrospective cohort study investigated adult COVID-19 Japanese patients who were triaged at Nagasaki University Hospital between April 1, 2021, and May 31, 2021. A triage checklist with 30 factors was used to identify patients requiring hospitalization. Patients recommended for isolation were followed up for later ED visit or hospital admission.
Results
Overall, 338 COVID-19 patients (mean age, 44.7; 45% women) visited the clinic at an average of 5.4 days after symptom onset. Thirty-six patients (10.6%) were hospitalized from triage, and the rest were recommended for isolation. Seventy-two non-hospitalized patients (23.8%) visited ED during their isolation period, and 30 (9.9%) were hospitalized after ED evaluation. The mean duration to ED visit and hospitalization after symptom onset were 8.8 and 9.7 days, respectively. Checklist factors associated with hospitalization during the isolation period were age > 50 years, obesity with BMI > 25, underlying hypertension, tachycardia with HR > 100/min or blood pressure >135 mmHg at triage, and >□3-day delay in hospital visit after symptom onset.
Conclusion
Clinicians should be wary of COVID-19 patients with above risk factors and prompt them to seek follow-up assessment by a medical professional.
SUMMARY AT A GLANCE
Overall, 338 patients with mild COVID-19 were retrospectively followed up. Factors such as age >□50 years, BMI□> □25, underlying hypertension, high blood pressure and tachycardia at triage, and delayed visit after symptom onset were associated with emergency department visit and hospitalization during the isolation period.
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SciScore for 10.1101/2022.05.23.22275444: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IACUC: Ethics: This study was approved by the Ethical Review Committee of NUH (permission number 21101927), and the study was conducted in accordance with the Declaration of Helsinki. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
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: We detected the following sentences addressing limitations in the study:The study has several limitations. First, this was a retrospective study and, …
SciScore for 10.1101/2022.05.23.22275444: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IACUC: Ethics: This study was approved by the Ethical Review Committee of NUH (permission number 21101927), and the study was conducted in accordance with the Declaration of Helsinki. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
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: We detected the following sentences addressing limitations in the study:The study has several limitations. First, this was a retrospective study and, therefore, has a potential for biases from incomplete clinician documentation. Second, follow-up information was not available after patients were discharged, which may have led to underestimated rates of hospitalization or mortality. Third, members of the team reviewing the ED revisits were not blinded, which may have introduced assessment bias. Fourth, since different variants of coronavirus have different clinical characteristics, important factors at the triage may be different during other pandemic waves. Lastly, the generalizability of the current study findings to other settings is limited by single-center design. Because of site-specific characteristics, it is possible that other ED sites with differences in availability of transportation and access to professional medical support may have different rates of outcomes than our own patient cohort. In summary, approximately 80% of patients with mild COVID-19 disease can be safely isolated at home in a facility. Ten percent of patients will experience progression of symptoms in the ensuing week that will require hospitalization for treatment—typically at 10 days of symptomatic illness. Clinicians should inform patients, especially those aged >□50 years, or those that are obese with BMI > 25, or those with underlying hypertension, or those presenting to the hospital > 3 days after symptom onset and presenting tachycardia (PR > 100/min) or high bl...
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.
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Results from scite Reference Check: We found no unreliable references.
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