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Epidemiology and clinical features of emergency department patients with suspected COVID-19: Insights from Australia's 'second wave' (COVED-4)

O'Reilly, GM, Mitchell, RD, Mitra, B, Akhlaghi, H, Tran, V ORCID: 0000-0002-8890-1457, Furyk, JS, Buntine, P, Wong, A, Gangathimmaiah, V, Knott, J, Raos, M, Chatterton, E, Sevior, C, Parker, S, Baker, S, Loughman, L, Lowry, N, Freeman, D, Sri-Ganeshan, M, Chapman, Nicole, Siu, S, Noonan, MP, Smit, D and Cameron, PA 2021 , 'Epidemiology and clinical features of emergency department patients with suspected COVID-19: Insights from Australia's 'second wave' (COVED-4)' , Emergency Medicine Australasia, vol. 33, no. 2 , pp. 331-342 , doi: 10.1111/1742-6723.13706.

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Abstract

Objective: The aim of the present study was to describe the epidemiology and clinical features of patients presenting to the ED with suspected and confirmed COVID-19 during Australia's 'second wave'.Methods: The COVID-19 ED (COVED) Project is an ongoing prospective cohort study in Australian EDs. This analysis presents data from 12 sites across four Australian states for the period from 1 July to 31 August 2020. All adult patients who met the criteria for 'suspected COVID-19' and underwent testing for SARS-CoV-2 in the ED were eligible for inclusion. Study outcomes included a positive SARS-CoV-2 test result, mechanical ventilation and in-hospital mortality.Results: There were 106 136 presentations to the participating EDs and 12 055 (11.4%; 95% confidence interval [CI] 11.2-11.6) underwent testing for SARS-CoV-2. Of these, 255 (2%) patients returned a positive result. Among positive cases, 13 (5%) received mechanical ventilation during their hospital admission compared to 122 (2%) of the SARS-CoV-2 negative patients (odds ratio 2.7; 95% CI 1.5-4.9, P = 0.001). Nineteen (7%) SARS-CoV-2 positive patients died in hospital compared to 212 (3%) of the SARS-CoV-2 negative patients (odds ratio 2.3; 95% CI 1.4-3.7, P = 0.001). Strong clinical predictors of the SARS-CoV-2 test result included self-reported fever, sore throat, bilateral infiltrates on chest X-ray, and absence of a leucocytosis on first ED blood tests (P Conclusions: In this prospective multi-site study during Australia's 'second wave', a substantial proportion of ED presentations required SARS-CoV-2 testing and isolation. Presence of SARS-CoV-2 on nasopharyngeal swab was associated with an increase in the odds of death and mechanical ventilation in hospital.

Item Type: Article
Authors/Creators:O'Reilly, GM and Mitchell, RD and Mitra, B and Akhlaghi, H and Tran, V and Furyk, JS and Buntine, P and Wong, A and Gangathimmaiah, V and Knott, J and Raos, M and Chatterton, E and Sevior, C and Parker, S and Baker, S and Loughman, L and Lowry, N and Freeman, D and Sri-Ganeshan, M and Chapman, Nicole and Siu, S and Noonan, MP and Smit, D and Cameron, PA
Keywords: COVID-19, emergency, isolation, quality improvement, registry
Journal or Publication Title: Emergency Medicine Australasia
Publisher: Blackwell Pub.
ISSN: 1742-6731
DOI / ID Number: 10.1111/1742-6723.13706
Copyright Information:

Copyright 2020 Australasian College for Emergency Medicine

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