Predictors of Care in Persons Under Investigation for COVID-19

Ventilation, ICU
The healthcare burden of the COVID-19 pandemic extends beyond patients who test positive for severe acute respiratory syndrome coronavirus 2.

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.

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“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.


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