Outcomes for emergency department patients with suspected and confirmed COVID-19: An analysis of the Australian experience in 2020 (COVED-5).

Abstract

The aim of this study was to describe the characteristics and outcomes of patients presenting to Australian emergency departments (EDs) with suspected and confirmed COVID-19 during 2020, and to determine the predictors of in-hospital death for SARS-CoV-2 positive patients. This analysis from the COVED Project presents data from twelve sites across four Australian states for the period from 1 April to 30 November 2020. All adult patients who met local criteria for suspected COVID-19 and underwent testing for SARS-CoV-2 in the ED were eligible for inclusion. Study outcomes were mechanical ventilation and in-hospital mortality. Among 24,405 eligible ED presentations over the whole study period, 423 tested positive for SARS-CoV-2. During the "second wave" from 1 July to 30 September 2020, 26 (6%) of 406 SARS-CoV-2 patients received invasive mechanical ventilation, compared to 175 (2%) of the 9,024 SARS-CoV-2 negative patients (OR 3.5; 95% CI: 2.3-5.2, p<0.001), and 41 (10%) SARS-CoV-2 positive patients died in hospital compared to 312 (3%) SARS-CoV-2 negative patients (OR 3.2; 95% CI: 2.2-4.4, p=0.001). For SARS-CoV-2 positive patients, the strongest independent predictors of hospital death were age (OR 1.1; 95% CI: 1.1-1.1, p<0.001), higher triage category (OR 3.5; 95% CI 1.3-9.4, p=0.012), obesity (OR 4.2; 95% CI: 1.2-14.3, p=0.024) and receiving immunosuppressive treatment (OR 8.2; 95% CI: 1.8-36.7, p=0.006). ED patients who tested positive for SARS-CoV-2 had higher odds of mechanical ventilation and death in hospital. The strongest predictors of death were age, a higher triage category, obesity and receiving immunosuppressive treatment. This article is protected by copyright. All rights reserved.