ABSTRACT
Objective@#The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus-2, is a global concern. This study aimed to examine the clinical characteristics, demographics and outcomes of COVID-19 patients in the emergency department (ED) and explore clinical predictors of in-hospital mortality. @*Methods@#This single-center, retrospective, observational study used 1,003 adult patients with laboratory-confirmed COVID-19 who went to the ED and were admitted to the hospital between February 28 and September 30, 2020. @*Results@#The median age of the included patients was 55 (37-68) years, and 533 were women (53.1%). Severe COVID-19 was noted in 173 patients (17.2%); seven patients (0.7%) received mechanical ventilation. The mortality rate was 2.1%. Multivariable Cox regression analysis found the risk factors associated with in-hospital death of patients (age >70 years [hazard ratio (HR), 27.411; P70 years, hypoalbuminemia, CURB-65≥3 and thrombocytopenia on admission were independent risk factors for mortality in patients hospitalized with COVID-19. Early detection of these predictors and application of CURB-65 score in the ED may provide guidance for appropriate risk stratification at triage and disposition of patients at increased risk of poor prognosis.
ABSTRACT
Objective@#This study examined the effects of the new law on life-sustaining treatment (LST) in emergency patients with advanced malignancy. @*Methods@#This was a retrospective before-after study performed at a single hospital. The enrollment criteria were as follows: patients who visited the emergency department during the study period, age ≥18 years, Korean Triage and Acuity Scale 1-2 to enroll severely ill patients requiring LST, solid malignancy with metastasis, and admitted to the study hospital. The after group was defined as those enrolled in May 2018, and the before group was defined as those enrolled in May 2017. The primary outcomes were defined as LST, including intensive care unit (ICU) admission, renal replacement therapy, mechanical ventilation, and cardiopulmonary resuscitation. Secondary outcomes were defined as each component of the primary outcomes, hospital length of stay, cost, and mortality. @*Results@#Ninety-seven patients were enrolled (before group [n=46], after group [n=51]). LST was provided more frequently in the after group (19.6% vs. 47.1%, P=0.004). The ICU admission rate was higher (19.6% vs. 43.1%, P=0.013), and mechanical ventilation was applied more frequently (6.5% vs. 21.6%, P=0.044) in the after group. Furthermore, the median hospital length of stay (six-day vs. 11-day, P=0.016) was longer, and the median hospital cost was higher (3,777 USD vs. 7,882 USD, P<0.001) in the after group. Hospital mortality did not differ (19.6% vs. 35.3%, P=0.084). @*Conclusion@#New end-of-life care law increased the rate of LST in emergency patients with advanced malignancy regardless of the improved survival rate.
ABSTRACT
Objective@#This study examined the effects of the new law on life-sustaining treatment (LST) in emergency patients with advanced malignancy. @*Methods@#This was a retrospective before-after study performed at a single hospital. The enrollment criteria were as follows: patients who visited the emergency department during the study period, age ≥18 years, Korean Triage and Acuity Scale 1-2 to enroll severely ill patients requiring LST, solid malignancy with metastasis, and admitted to the study hospital. The after group was defined as those enrolled in May 2018, and the before group was defined as those enrolled in May 2017. The primary outcomes were defined as LST, including intensive care unit (ICU) admission, renal replacement therapy, mechanical ventilation, and cardiopulmonary resuscitation. Secondary outcomes were defined as each component of the primary outcomes, hospital length of stay, cost, and mortality. @*Results@#Ninety-seven patients were enrolled (before group [n=46], after group [n=51]). LST was provided more frequently in the after group (19.6% vs. 47.1%, P=0.004). The ICU admission rate was higher (19.6% vs. 43.1%, P=0.013), and mechanical ventilation was applied more frequently (6.5% vs. 21.6%, P=0.044) in the after group. Furthermore, the median hospital length of stay (six-day vs. 11-day, P=0.016) was longer, and the median hospital cost was higher (3,777 USD vs. 7,882 USD, P<0.001) in the after group. Hospital mortality did not differ (19.6% vs. 35.3%, P=0.084). @*Conclusion@#New end-of-life care law increased the rate of LST in emergency patients with advanced malignancy regardless of the improved survival rate.