Factors associated with hospital admission and adverse outcome for COVID-19: Role of social factors and medical care.

BACKGROUND: Beyond sex, age, and various comorbidities, geographical origin and socioeconomic deprivation are associated with Coronavirus Disease (COVID-19) morbidity and mortality in the general population. We aimed to assess factors associated with severe forms of COVID-19 after a hospital emergency department visit, focusing on socioeconomic factors. METHODS: Patients with laboratory-confirmed COVID-19 attending the emergency department of Béclère Hospital (France) in March-April 2020 were included. Postal addresses were used to obtain two geographical deprivation indices at the neighborhood level. Factors associated with hospitalization and factors associated with adverse outcomes, i.e. mechanical ventilation or death, were studied using logistic and Cox analyses, respectively. RESULTS: Among 399 included patients, 321 were hospitalized. Neither geographical origin nor socioeconomic deprivation was associated with any of the outcomes. Being male, older, overweight or obese, diabetic, or having a neuropsychiatric disorder were independent risk factors for hospitalization. Among 296 patients hospitalized at Béclère Hospital, 91 experienced an adverse outcome. Older age, being overweight or obese, desaturation and extent of chest CT scan lesions>25% at admission (aHR: 2.2 [95% CI: 1.3-3.5]) and higher peak CRP levels and acute kidney failure (aHR: 2.0 [1.2-3.3]) during follow-up were independently associated with adverse outcomes, whereas treatment with hydrocortisone reduced the risk of mechanical ventilation or death by half (aHR: 0.5 [0.3-0.8]). CONCLUSION: No association between geographical origin or socioeconomic deprivation and the occurrence of a severe form of COVID-19 was observed in our population after arrival to the emergency department. Empirical corticosteroid use with hydrocortisone had a strong protective impact.

[Treatment of GP's telephone requests for admission. Assessment of departments for 4 medical specialties]. / Programmation d'une hospitalisation sur appel d'un médecin généraliste.

OBJECTIVES: To assess the capacity of 4 types of medical departments in the Paris hospital network (AP-HP) to plan hospitalization following a telephoned request from a GP (who do not have hospital admitting privileges). METHOD: Four simulated cases were designed to present a specific problem, requiring prompt but not urgent admission into a department of internal medicine, rheumatology, gastroenterology and neurology. The experiment took place from January 17 through 12 February 2002, during standard office hours: an investigator posing as a locum tenens covering for a general practitioner called the hospital switchboard, requested the department, asked to speak to someone able to arrange the admission, and provided details of the simulated case. When a single hospital had several departments of the same specialty, we made only one telephone call. The details recorded in each case were principally the time elapsed for each stage and the final result. RESULTS: We contacted 55 medical departments: 19 of the 20 internal medicine departments in the network, all 9 rheumatology, all 19 gastroenterology, and 8 of 13 neurology departments. The mean time spent on the phone was 5.04 min (range 1.40-10.14, SD 2.20). Justification for the referral was never questioned. Twenty-two (40%) referrals succeeded: 10/19 (53%) in internal medicine, 4/9 (44%) in rheumatology, 6/19 (32%) in gastroenterology, and 2/8 (25%) in neurology. Admission could not be arranged in 33 (60%) cases because: no one able to arrange the admission was available for 17 cases (31%) (the person was in a meeting 9 times and could not be found 8); no bed was available in 13 (24%). Alternatives solutions were proposed in 10 of these 13 cases: call the emergency unit (6/13), or call another hospital (3/13). CONCLUSION: Only hospital reorganization and regular assessments can improve the procedure for handling GP referrals for admission.