Ward vs. emergency department discharge in patients with COVID-19: Does it make a difference to symptom burden and radiological severity at follow up?

ABSTRACT

Background During the COVID-19 pandemic patients were often discharged following assessment within the Emergency Department (ED). However, to our knowledge no data exists on whether these patients are likely to have a better trajectory of recovery. We investigated the symptom burden and radiological severity at follow-up for patients discharged directly from ED compared to those admitted. Methods Patients diagnosed with COVID-19 between 05.03.20 and 05.05.20 discharged from ED or the ward had telephone assessments 8-10 weeks post-discharge. Demographics, co-morbidities, symptom burden (quantified using a numerical rating scale) and psychological health data were collected. Patients were offered a follow-up chest radiograph (CXR) if abnormal on discharge. Results During this period we contacted 188 ED and 471 ward discharges, median (IQR) follow up 77.5 days (65-87) and 64 days (55-82) respectively. The baseline demographic data is shown in table 1. Ward patients were significantly older (62.5 vs. 53.8 years, p<0.001), more likely to be hypertensive (49% vs. 27%, p<0.001), diabetic (31% vs. 16%, p=0.004), frailer (median clinical frailty score 2(2-5) vs. 2(2-3), p<0.001) and have a higher NEWS2 score (5 (2-7) vs. 2 (1-4), p<0.001). There were no significant differences in other characteristics including ethnicity, heart disease and smoking. 115 (61%) ED and 340 (72%) ward patients completed follow-up calls. There were no significant differences in symptom burden (breathlessness, cough, fatigue, sleep quality) and psychological burden (assessed by screening questionnaires). No significant difference was noted in the proportion able to return to work (ED vs. ward 70% vs. 59%, p=0.111). Finally, 5% of ED patients had an unchanged/worsening CXR compared to 9% discharged from the ward (p=0.42). Conclusion Our data confirms that patients admitted to hospital are likely to be more unwell, older, more frail and have hypertension and diabetes. Despite this, there were no significant differences in symptoms or radiological severity at follow up, suggesting that hospitalised patients do not appear to have worse physical or psychological sequelae compared to those discharged directly from ED. We should develop strategies to identify the patients who are more likely to suffer from longterm sequelae post COVID-19, to appropriately establish a targeted follow-up service.