5PSQ-213 Hospital admissions after discharge from the emergency department to home with COVID-19 treatment

Abstract

Background and importance During the March and April, over 700 patients were discharged from the emergency department (ED) in a third level hospital to home with treatment for COVID-19. Their characteristics and final outcomes remain unknown. Aim and objectives To analyse the characteristics and clinical course of COVID-19 patients that were discharged from the ED with home treatment, having to be hospitalised afterwards due to clinical deterioration, and to record the most commonly prescribed drugs for COVID-19. Material and methods An observational retrospective study was conducted between 1 March and 10 April 2020. Hospitalised patients diagnosed with COVID-19 who had previously attended the ED and were discharged home were included. The following data were recorded: demographic, comorbidities, COVID-19 treatment, fever ≥38°C, tachypnoea, reason for consultation and admission, days between the first and second visit to the ED, days of hospitalisation, length of intensive care unit (ICU) stay if any and reason for discharge. Results 741 patients were discharged from the ED with home treatment for COVID-19, of whom 68 (9.2%) needed to be hospitalised. Median age was 55.5 years (IR 22–88) and 66.1% were men. 64.7% had comorbidities, mainly: hypertension 44.2%, dyslipidaemia 16.2% and asthma 8.8%. Patients were prescribed as home treatment hydroxychloroquine (100%), azithromycin (75%) and lopinavir/ritonavir (22.1%). Median number of days until patients went back to the ED was 4. The main reasons for consultations were dyspnoea (80.8%), fever (61.7%), coughing (42.6%) and anosmia/dysgeusia (10.3%). 32.4% had tachypnoea and 26.5% had fever. The main reasons for admission were clinical and radiological worsening (85.3%). Median inpatient stay was 7 days (IR 4–13), and 67.7% were hospitalised for less than 10 days. 8.8% needed critical care and stayed in the ICU for a median of 10.5 days (IR 6–16). The following drugs were prescribed as COVID-19 treatment during hospitalisation: lopinavir/ritonavir (86.8%), hydroxychloroquine (86.8%), corticosteroids (63.2%), ceftriaxone (58.8%), azithromycin (50%), tocilizumab (14.7%), remdesivir (4.4%) and anakinra (2.9%). One patient died and the rest were discharged to home. Conclusion and relevance Patients who needed hospitalisation due to clinical worsening after being discharged from the ED were mostly middle age men with hypertension. About 80% were admitted for presenting with dyspnoea and rapid radiological progression. Less than 10% needed intensive care, and only one died. Most showed clinical improvement in less than 10 days and were discharged home. Drugs most commonly prescribed for COVID-19 were hydroxychloroquine, azithromycin and lopinavir/ritonavir. References and/or acknowledgements Conflict of interest No conflict of interest