Evaluation of a Triage Checklist for Mild COVID-19 Outpatients in Predicting Subsequent Emergency Department Visits and Hospitalization during the Isolation Period: A Single-Center Retrospective Study

  1. Yasuhiro Tanaka
  2. Kazuko Yamamoto
  3. Shimpei Morimoto
  4. Takeshi Nabeshima
  5. Kayoko Matsushima
  6. Hiroshi Ishimoto
  7. Nobuyuki Ashizawa
  8. Tatsuro Hirayama
  9. Kazuaki Takeda
  10. Hiroshi Gyotoku
  11. Naoki Iwanaga
  12. Shinnosuke Takemoto
  13. Susumu Fukahori
  14. Takahiro Takazono
  15. Hiroyuki Yamaguchi
  16. Takashi Kido
  17. Noriho Sakamoto
  18. Naoki Hosogaya
  19. Shogo Akabame
  20. Takashi Sugimoto
  21. Hirotomo Yamanashi
  22. Kosuke Matsui
  23. Mai Izumida
  24. Ayumi Fujita
  25. Masato Tashiro
  26. Takeshi Tanaka
  27. Koya Ariyoshi
  28. Akitsugu Furumoto
  29. Kouichi Morita
  30. Koichi Izumikawa
  31. Katsunori Yanagihara
  32. Hiroshi Mukae

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Abstract

Managing mild illness in COVID-19 and predicting progression to severe disease are concerning issues. Here, we investigated the outcomes of Japanese patients with mild COVID-19, and identified triage risk factors for further hospitalization and emergency department (ED) visits at a single tertiary hospital. A triage checklist with 30 factors was used. Patients recommended for isolation were followed up for 10 days for subsequent ED visits or hospital admission. Overall, 338 patients (median age, 44.0; 45% women) visited the clinic 5.0 days (median) after symptom onset. Thirty-six patients were immediately hospitalized following triage; others were isolated. In total, 72 non-hospitalized patients visited the ED during their isolation, and 30 were hospitalized after evaluation for oxygen desaturation. The median ED visit and hospitalization durations after symptom onset were 5.0 and 8.0 days, respectively. The checklist factors associated with hospitalization during isolation were age > 50 years, body mass index > 25 kg/m2, hypertension, tachycardia with pulse rate > 100/min or blood pressure > 135 mmHg at triage, and >3-day delay in hospital visit after symptom onset. No patients died. Altogether, 80% of patients with mild COVID-19 could be safely isolated at home. Age, BMI, underlying hypertension, date after symptom onset, tachycardia, and systolic blood pressure at triage might be related to later hospitalization.

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  1. Version published to 10.3390/jcm11185444
  2. ScreenIT

    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

    EthicsIACUC: 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 variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot 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.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a protocol registration statement.

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

    About SciScore

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  3. Version published to 10.1101/2022.05.23.22275444v1 on medRxiv