Clinical Characteristics Associated With Return Visits to the Emergency Department After COVID-19 Diagnosis

Iltifat Husain, MD; James O'Neill, MD; Rachel Mudge, MD; Alicia Bishop, MD; K. Alexander Soltany, BA; Jesse Heinen, BS; Chase Countryman, MD; Dillon Casey, MD; David Cline, MD

Disclosures

Western J Emerg Med. 2021;22(6):1257-1261. 

In This Article

Results

Our study included 235 adult patients who had an ED-performed SARS-CoV-2 rRT-PCR positive test and were subsequently discharged on their first ED visit. Of these patients, 57 (24.3%) had return visits to the ED within 30 days for symptoms related to COVID-19. Of these 57 patients, on return ED visits 27 were admitted to the hospital and 30 were not admitted. Of the 235 adult patients who were discharged, 11.5% (27) eventually required admission for COVID-19 related symptoms. With 24.3% of patients having a return ED visit after a positive SARS-CoV-2 test and 11.5% requiring eventual admission, it is important to understand clinical characteristics associated with return ED visits.

Table 1 lists clinical characteristics and their univariate association with return to the ED. The chronic conditions that we found significantly associated with return ED visits were diabetes (OR 3.06, 95% CI, 1.52–6.13, P = 0.002) and hypertension (OR 2.18, 95% CI, 1.17–4.05, P = 0.013). Patients between ages 50–69 were more likely to have a return ED visit (OR 1.89, 95% CI, 1.02–3.50, P = 0.042). While patients with return ED visits had a higher percentage of abnormal chest radiographs at their index ED visit than those who did not return (42.1% to 28.1%), this was not statistically significant. Lab abnormalities significantly associated with higher return visits were transaminitis (OR 3.99, 95% CI, 1.53–10.4, P < 0.001); thrombocytopenia (OR 3.0, 95% CI, 1.2–7.2, P = 0.012); and abnormal glomerular filtration rate (OR 4.1, 95% CI, 1.2–13.9, P = 0.025). Interestingly, diagnostic markers used for risk stratification, such as D-dimer and lymphopenia, were not significantly associated with higher return visits to the ED. Neither were health insurance status or race significantly associated with higher return visits to the ED. We analyzed triage and discharge vital signs from patient index visits and found heart rate ≥ 90 during triage and discharge was significantly associated with return ED visits.

Table 2 lists those clinical characteristics that retained independent association with a return visit to the ED after the index visit to the ED due to COVID-19. These clinical characteristics included increased pulse at triage, (OR 1.043, 95% CI, 1.020–1.065, P = 0.0002; myalgia, (OR 4.427, 95% CI, 2.028–9.663, P = 0.0002; history of diabetes mellitus, (OR 2.990, 95% CI, 1.208–7.403, P = 0.0179; and transaminitis (OR 8.973, 95% CI, 2.654–30.333, P = 0.0004. Transaminitis was defined as any abnormal elevation in aspartate aminotransferase or alanine aminotransferase above the laboratory-defined upper limit of normal.

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