Derivation and validation of a clinical decision rule to risk-stratify COVID-19 patients discharged from the emergency department: The CCEDRRN COVID discharge score.

Objective: To risk-stratify COVID-19 patients being considered for discharge from the emergency department (ED). Methods: We conducted an observational study to derive and validate a clinical decision rule to identify COVID-19 patients at risk for hospital admission or death within 72 hours of ED discharge. We used data from 49 sites in the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) between March 1, 2020, and September 8, 2021. We randomly assigned hospitals to derivation or validation and prespecified clinical variables as candidate predictors. We used logistic regression to develop the score in a derivation cohort and examined its performance in predicting short-term adverse outcomes in a validation cohort. Results: Of 15,305 eligible patient visits, 535 (3.6%) experienced the outcome. The score included age, sex, pregnancy status, temperature, arrival mode, respiratory rate, and respiratory distress. The area under the curve was 0.70 (95% confidence interval [CI] 0.68-0.73) in derivation and 0.71 (95% CI 0.68-0.73) in combined derivation and validation cohorts. Among those with a score of 3 or less, the risk for the primary outcome was 1.9% or less, and the sensitivity of using 3 as a rule-out score was 89.3% (95% CI 82.7-94.0). Among those with a score of ≥9, the risk for the primary outcome was as high as 12.2% and the specificity of using 9 as a rule-in score was 95.6% (95% CI 94.9-96.2). Conclusion: The CCEDRRN COVID discharge score can identify patients at risk of short-term adverse outcomes after ED discharge with variables that are readily available on patient arrival.

Development of the Canadian COVID-19 Emergency Department Rapid Response Network population-based registry: a methodology study.

BACKGROUND: Emergency physicians lack high-quality evidence for many diagnostic and treatment decisions made for patients with suspected or confirmed coronavirus disease 2019 (COVID-19). Our objective is to describe the methods used to collect and ensure the data quality of a multicentre registry of patients presenting to the emergency department with suspected or confirmed COVID-19. METHODS: This methodology study describes a population-based registry that has been enrolling consecutive patients presenting to the emergency department with suspected or confirmed COVID-19 since Mar. 1, 2020. Most data are collected from retrospective chart review. Phone follow-up with patients at 30 days captures the World Health Organization clinical improvement scale and contextual, social and cultural variables. Phone follow-up also captures patient-reported quality of life using the Veterans Rand 12-Item Health Survey at 30 days, 60 days, 6 months and 12 months. Fifty participating emergency departments from 8 provinces in Canada currently enrol patients into the registry. INTERPRETATION: Data from the registry of the Canadian COVID-19 Emergency Department Rapid Response Network will be used to derive and validate clinical decision rules to inform clinical decision-making, describe the natural history of the disease, evaluate COVID-19 diagnostic tests and establish the real-world effectiveness of treatments and vaccines, including in populations that are excluded or underrepresented in clinical trials. This registry has the potential to generate scientific evidence to inform our pandemic response, and to serve as a model for the rapid implementation of population-based data collection protocols for future public health emergencies. TRIAL REGISTRATION: Clinicaltrials.gov, no. NCT04702945.

CO-aVoID: coronavirus outbreak affecting variability of presentations to a local emergency department.

BACKGROUND: The impact of the COVID-19 pandemic on public health, specifically on patients presenting to the emergency department (ED) with non-COVID-related diseases, remains largely undocumented. OBJECTIVE: This study explored how overall rates of presentations to the emergency department were impacted immediately after the declaration of the COVID-19 pandemic, and specifically how key presenting symptoms representing emergency, standard and low-acuity conditions were impacted. METHODS: A sequential modified Delphi survey and cross-sectional analysis of administrative census data from a tertiary care center in New Brunswick, Canada, were performed. Details of ED presentations for emergency, standard and low-acuity conditions from February 1 to April 30, 2020, were compared to data from previous years. RESULTS: There was a significant decrease in the number of patients visiting the ED with emergency, standard and low-acuity complaints immediately after March 13, 2020, compared to 2019. The proportion of females and males remained similar, with a median age of 48 years in 2020 and 44 years in 2019. Total presentation patterns to the ED (registrations, admissions to hospital and left without being seen numbers) decreased, compared to previous years. CONCLUSIONS: We report a predictable decrease in patient visits to the ED with minor, non-life-threatening conditions during a pandemic. However, we also report a decrease in presentations for emergency and standard conditions. Improved messaging highlighting the need to seek help for "true" emergencies, while providing non-ED options for minor, non-life-threatening conditions, may be helpful under normal circumstances and during future pandemics.

RéSUMé: CONTEXTE: L'impact de la pandémie COVID-19 sur la santé publique, en particulier sur les patients se présentant aux services d'urgence (SU) avec des maladies non liées à la COVID, demeure en grande partie non documenté. OBJECTIF: Cette étude a exploré la façon dont les taux globaux de présentations au service des urgences ont été touchés immédiatement après la déclaration de la pandémie de COVID-19, et plus particulièrement la façon dont les principaux symptômes représentant des conditions d'urgence, standard et de faible acuité ont été touchés. MéTHODES: Une enquête Delphi séquentielle modifiée et une analyse transversale des données du recensement administratif provenant d'un centre de soins tertiaires du Nouveau-Brunswick, au Canada, ont été réalisées. Les détails des présentations du SU pour les conditions d'urgence, standard et de faible acuité du 1er février au 30 avril 2020 ont été comparés aux données des années précédentes. RéSULTATS: Il y a eu une diminution significative du nombre de patients se rendant au service d'urgence avec des plaintes d'urgence, standard et de faible gravité immédiatement après le 13 mars 2020, par rapport à 2019. La proportion de femmes et d'hommes est demeurée semblable, avec un âge médian de 48 ans en 2020 et de 44 ans en 2019. Le nombre total de modèles de présentation à l'urgence (inscriptions, admissions à l'hôpital et nombre laissé sans être vu) a diminué par rapport aux années précédentes. CONCLUSIONS: Nous faisons état d'une diminution prévisible des visites de patients aux urgences pour des affections mineures qui ne mettent pas leur vie en danger pendant une pandémie. Toutefois, nous signalons également une diminution des présentations pour les situations d'urgence et les conditions normales. Des messages améliorés soulignant la nécessité de demander de l'aide pour les urgences « réelles ¼, tout en offrant des options non urgentes pour des conditions mineures et qui ne mettent pas la vie en danger peuvent être utiles dans des circonstances normales et lors de futures pandémies.