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Clinical and imaging characteristics of patients with COVID-19 predicting hospital readmission after emergency department discharge: a single-centre cohort study in Italy.
Galli, Maria Giulia; Djuric, Olivera; Besutti, Giulia; Ottone, Marta; Amidei, Lucia; Bitton, Lee; Bonilauri, Carlotta; Boracchia, Luca; Campanale, Sergio; Curcio, Vittoria; Lucchesi, Davide Maria Francesco; Mulas, Cesare Salvatore; Santi, Francesca; Ferrari, Anna Maria; Giorgi Rossi, Paolo; Luppi, Francesco.
  • Galli MG; Emergency Department, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy.
  • Djuric O; Epidemiology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy.
  • Besutti G; Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, Center for Environmental, Nutritional and Genetic Epidemiology (CREAGEN), University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy.
  • Ottone M; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy.
  • Amidei L; Radiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy.
  • Bitton L; Epidemiology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy marta.ottone@ausl.re.it.
  • Bonilauri C; Emergency Department, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy.
  • Boracchia L; Emergency Department, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy.
  • Campanale S; Emergency Department, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy.
  • Curcio V; Emergency Department, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy.
  • Lucchesi DMF; Emergency Department, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy.
  • Mulas CS; Emergency Department, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy.
  • Santi F; Emergency Department, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy.
  • Ferrari AM; Emergency Department, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy.
  • Giorgi Rossi P; Emergency Department, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy.
  • Luppi F; Emergency Department, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy.
BMJ Open ; 12(4): e052665, 2022 04 06.
Article in English | MEDLINE | ID: covidwho-1779369
ABSTRACT

OBJECTIVE:

We aimed at identifying baseline predictive factors for emergency department (ED) readmission, with hospitalisation/death, in patients with COVID-19 previously discharged from the ED. We also developed a disease progression velocity index. DESIGN AND

SETTING:

Retrospective cohort study of prospectively collected data. The charts of consecutive patients with COVID-19 discharged from the Reggio Emilia (Italy) ED (2 March 2 to 31 March 2020) were retrospectively examined. Clinical, laboratory and CT findings at first ED admission were tested as predictive factors using multivariable logistic models. We divided CT extension by days from symptom onset to build a synthetic velocity index.

PARTICIPANTS:

450 patients discharged from the ED with diagnosis of COVID-19. MAIN OUTCOME

MEASURE:

ED readmission within 14 days, followed by hospitalisation/death.

RESULTS:

Of the discharged patients, 84 (18.7%) were readmitted to the ED, 61 (13.6%) were hospitalised and 10 (2.2%) died. Age (OR=1.05; 95% CI 1.03 to 1.08), Charlson Comorbidity Index 3 versus 0 (OR=11.61; 95% CI 1.76 to 76.58), days from symptom onset (OR for 1-day increase=0.81; 95% CI 0.73 to 0.90) and CT extension (OR for 1% increase=1.03; 95% CI 1.01 to 1.06) were associated in a multivariable model for readmission with hospitalisation/death. A 2-day lag velocity index was a strong predictor (OR for unit increase=1.21, 95% CI 1.08 to 1.36); the model including this index resulted in less information loss.

CONCLUSIONS:

A velocity index combining CT extension and days from symptom onset predicts disease progression in patients with COVID-19. For example, a 20% CT extension 3 days after symptom onset has the same risk as does 50% after 10 days.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Patient Readmission / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Limits: Humans Language: English Journal: BMJ Open Year: 2022 Document Type: Article Affiliation country: Bmjopen-2021-052665

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Patient Readmission / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Limits: Humans Language: English Journal: BMJ Open Year: 2022 Document Type: Article Affiliation country: Bmjopen-2021-052665