Predictors of Care in Persons Under Investigation for COVID-19

The healthcare burden of the coronavirus disease 2019 (COVID-19) pandemic extends beyond patients who test positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), according to a retrospective cohort study published in the Annals of Emergency Medicine.

During the COVID-19 pandemic, most reports have focused on patients who test positive for SARS-CoV-2; however, stress on the health care system has also occurred because of the surge in the number of persons under investigation (PUI) with symptoms possibly but not exclusively as a result of COVID-19. Because of shortages in testing, delays in test results, false negatives, and daily fluctuations in test results within individual parties, all PUI must be considered to have COVID-19 until proven otherwise.

Researchers described their experience with 4404 PUI presenting to a large academic medical center emergency department (ED) in New York State where they explored predictors of intensive care unit (ICU) care and invasive mechanical ventilation.

A total of 68% of these PUI were discharged home, while 29% were admitted to a regular floor, and 3% were admitted to an ICU. To date, 1651 of 2897 tests available (57%) were positive for SARS-CoV-2. Of patients admitted to regular floors, 13% were subsequently upgraded to the ICU after a median of 62 hours. In addition, 50 patients required invasive mechanical ventilation in the ED, 4 required prehospital invasive mechanical ventilation, and 167 subsequently required invasive mechanical ventilation within a median of 60 hours of admission.

Testing positive for SARS-Cov-2 and having lower oxygen saturations were associated with the need for ICU admission, invasive mechanical ventilation, and death, while high respiratory rates were associated with the need for ICU care.

“For every 100 admitted PUI, 9 will require ICU and/or [invasive mechanical ventilation] upon arrival and another 12 within 2-3 days of hospital admission, especially PUIs with lower oxygen saturations and positive SARS-CoV-2 swabs,” the study authors wrote.

Reference

Singer AJ, Morley EJ, Meyers K, et al. Cohort of 4404 persons under investigation for COVID-19 in a NY hospital and predictors of ICU care and ventilation [published online May 11, 2020]. Ann Emerg Med. doi:10.1016/j.annemergmed.2020.05.011