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.

Conclusion

Our study identified key clinical characteristics associated with return ED visits for patients initially diagnosed with SARS-CoV-2 infection: diabetes mellitus; increased pulse at triage; transaminitis; and complaint of myalgias.

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Table 1. Univariate analysis: clinical characteristics of patients with return visits to the emergency department after being diagnosed with coronavirus 2019.
Clinical characteristics (Initial ED visit)	Total N = 235	No return ED visit N = 178 N (% cohort)	Return ED visit N = 57 N (% cohort)	Odds ratio (95% CI)	Standard error	P-value
Age
18–49	151	120 (67.4)	31(54.4)	0.58 (0.31–1.06)	0.31	0.076
50–69	77	52 (29.2)	25 (43.9)	1.89 (1.02–3.50)	0.31	0.042
>70	7	6 (3.3)	1 (1.8)	1.16 (0.39–3.28)	0.54	0.827
Chronic conditions
Asthma or COPD	30	24 (13.5)	6 (10.5)	0.76 (0.29–1.95)	0.48	0.561
Diabetes	44	25 (14.0)	19 (33.3)	3.06 (1.52–6.13)	0.35	0.002
Hypertension	72	47 (26.4)	25 (43.9)	2.18 (1.17–4.05)	0.32	0.013
Vital signs
HR < 89 (triage)	96	80 (44.9)	16 (28.1)	0.478 (0.24–0.91)	0.33	0.026
HR > 90 (triage)	139	98 (55.1)	41 (71.9)	2.09 (1.09–4.00)	0.33	0.026
HR < 89 (discharge)	168	138 (77.5)	30 (52.6)	0.322 (0.17–0.60)	0.32	0.001
HR > 90 (discharge)	67	40 (22.5)	27 (47.4)	3.11 (1.66–5.82)	0.32	0.001
Lab/imaging
Chest CXR normal	88	69 (38.8)	19 (33.3)	0.79 (0.41–1.47)	0.32	0.461
Chest CXR abnormal	74	50 (28.1)	24 (42.1)	1.86 (1.00–3.45)	0.32	0.047
Chest CXR not ordered	73	59 (33.1)	14 (24.6)	0.65 (0.33–1.29)	0.34	0.225
Transaminitis	19	9 (5.1)	10 (52.6)	3.99 (1.53–10.4	0.48	<0.0001
Thrombocytopenia	24	13 (7.3)	11 (19.3)	3.0 (1.2–7.2)	0.44	0.012
Lymphopenia	34	24 (13.5)	10 (17.5)	1.36 (0.6–3.6)	0.41	0.449
D-dimer positive	9	7 (3.9)	2 (3.5)	0.88 (0.17–4.4)	0.81	0.885
GFR abnormal	11	5 (2.8)	6 (10.5)	4.1 (1.2–13.9)	0.62	0.025
Labs not ordered	109	89 (50.0)	20 (35.1)	0.541 (0.29–1.00)	0.31	0.051
Health insurance (Y)	112	81 (45.5)	31 (54.4)	1.47 (0.80–2.67)	0.31	0.212
Weight
BMI < 25	59	49 (27.5)	10 (17.5)	0.56 (0.26–1.19)	0.39	0.134
Overweight (BMI 25 to 29.9)	52	38 (21.3)	14 (24.6)	1.2 (0.60–2.42)	0.36	0.611
Obesity (BMI > 30)	124	91 (51.1)	33 (57.9)	1.31 (0.72–2.40)	0.31	0.375
Race/Ethnicity
Asian, non-Hispanic	5	4 (2.2)	1 (1.8)	0.777 (0.08–7.10)	0.17	0.746
Black, non-Hispanic	50	37 (20.8)	13 (22.8)	1.13 (0.55–2.31)	0.37	0.746
Other race, non-Hispanic	5	3 (1.7)	2 (3.5)	2.21 (0.35–13.02)	0.93	0.417
White, non-Hispanic	61	46 (25.8)	15 (26.3)	1.03 (0.52–2.02)	0.35	0.943
Hispanic	114	88 (49.4)	26 (45.6)	0.858 (0.47–1.56)	0.31	0.615

ED, emergency department; CI, confidence interval; COPD, chronic obstructive pulmonary disease; HR, heart rate; CXR, chest radiograph; GFR, glomerular filtration rate; BMI, body mass index.

Table 2. Multivariate logistic regression: clinical characteristics independently associated with return to the emergency department after the initial visit for COVID-19 infection.
Clinical characteristic	Odds ratio	95% Confidence interval		P-value
Pulse at triage (increasing)*	1.04	1.02	1.07	0.0002
Myalgia	4.43	2.03	9.66	0.0002
History of diabetes mellitus	2.99	1.21	7.40	0.0179
Transaminitis	8.97	2.65	30.33	0.0004