Characterisation of 22445 patients attending UK emergency departments with suspected COVID-19 infection: Observational cohort study

  1. Steve Goodacre
  2. Ben Thomas
  3. Ellen Lee
  4. Laura Sutton
  5. Amanda Loban
  6. Simon Waterhouse
  7. Richard Simmonds
  8. Katie Biggs
  9. Carl Marincowitz
  10. Jose Schutter
  11. Sarah Connelly
  12. Elena Sheldon
  13. Jamie Hall
  14. Emma Young
  15. Andrew Bentley
  16. Kirsty Challen
  17. Chris Fitzsimmons
  18. Tim Harris
  19. Fiona Lecky
  20. Andrew Lee
  21. Ian Maconochie
  22. Darren Walter

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

Hospital emergency departments play a crucial role in the initial assessment and management of suspected COVID-19 infection. This needs to be guided by studies of people presenting with suspected COVID-19, including those admitted and discharged, and those who do not ultimately have COVID-19 confirmed. We aimed to characterise patients attending emergency departments with suspected COVID-19, including subgroups based on sex, ethnicity and COVID-19 test results.

Methods and findings

We undertook a mixed prospective and retrospective observational cohort study in 70 emergency departments across the United Kingdom (UK). We collected presenting data from 22445 people attending with suspected COVID-19 between 26 March 2020 and 28 May 2020. Outcomes were admission to hospital, COVID-19 result, organ support (respiratory, cardiovascular or renal), and death, by record review at 30 days. Mean age was 58.4 years, 11200 (50.4%) were female and 11034 (49.6%) male. Adults (age >16 years) were acutely unwell (median NEWS2 score of 4), frequently had limited performance status (46.9%) and had high rates of admission (67.1%), COVID-19 positivity (31.2%), organ support (9.8%) and death (15.5%). Children had much lower rates of admission (27.4%), COVID-19 positivity (1.2%), organ support (1.4%) and death (0.3%). Similar numbers of men and women presented to the ED, but men were more likely to be admitted (72.9% v 61.4%), require organ support (12.2% v 7.7%) and die (18.2% v 13.0%). Black or Asian adults tended to be younger than White adults (median age 54, 50 and 67 years), were less likely to have impaired performance status (43.1%, 26.8% and 51.6%), be admitted to hospital (60.8%, 57.3%, 69.6%) or die (11.6%, 11.2%, 16.4%), but were more likely to require organ support (15.9%, 14.3%, 8.9%) or have a positive COVID-19 test (40.8%, 42.1%, 30.0%). Adults admitted with suspected and confirmed COVID-19 had similar age, performance status and comorbidities (except chronic lung disease) to those who did not have COVID-19 confirmed, but were much more likely to need organ support (22.2% v 8.9%) or die (32.1% v 15.5%).

Conclusions

Important differences exist between patient groups presenting to the emergency department with suspected COVID-19. Adults and children differ markedly and require different approaches to emergency triage. Admission and adverse outcome rates among adults suggest that policies to avoid unnecessary ED attendance achieved their aim. Subsequent COVID-19 confirmation confers a worse prognosis and greater need for organ support.

Registration

ISRCTN registry, ISRCTN56149622, http://www.isrctn.com/ISRCTN28342533 .

Article activity feed

  1. Version published to 10.1371/journal.pone.0240206
  2. ScreenIT

    SciScore for 10.1101/2020.08.10.20171496: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementConsent: We did not seek consent to collect data but information about the study was provided in the ED and patients could withdraw their data at their request.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot 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:
    Our study is based on a large and generalizable cohort covering the first wave of the pandemic, but has some limitations. A combination of prospective and retrospective data collection was used, and infection control measures limited our ability to collect data directly from patients. Reliance on clinical records may have underestimated the prevalence of some presenting features and comorbidities, and resulted in missing data for some variables. Selection of cases was based on subjective clinical judgement that COVID-19 was a suspected diagnosis, which may have been applied in a variable manner between clinicians and between sites. Our analysis was limited to describing the cohort rather than using multivariable analysis to explain the observed differences between groups. We felt that the latter analysis would need to be based on a clear theoretical rationale and inclusion of appropriate covariates, which would be beyond the scope of this study. In summary, we have shown important differences between patient groups presenting to the ED with suspected COVID-19. Adults and children differ markedly and require different approaches to emergency triage. Admission and adverse outcome rates among adults suggest that policies to avoid unnecessary ED attendance achieved their aim. Subsequent COVID-19 confirmation confers a worse prognosis and greater need for organ support. Ethical approval: The North West – Haydock Research Ethics Committee gave a favourable opinion on the PAINTED st...

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

    IdentifierStatusTitle
    ISRCTN56149622NANA
    ISRCTN28342533NANA

    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

    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 10.1101/2020.08.10.20171496v1 on medRxiv