Factors associated with readmission to the Emergency Department in a cohort of COVID-19 hospitalized patients
1Faculty of Medicine, University of Granada, 18016 Granada, Spain
2Service of Preventive Medicine and Public Health, Hospital Universitario Clínico San Cecilio, 18016 Granada, Spain
3Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain
4Instituto Biosanitario de Granada (ibs.GRANADA), 37007 España, Spain
5Department of Radiology, Virgen de las Nieves University Hospital, 18016 Granada, Spain
6PhD Programme in Clinical Medicine and Public Health, University of Granada, 18016 Granada, Spain
7Department of Medicine, University of Granada, 18016 Granada, Spain
8Intensive Care Unit, Hospital de Poniente, El Ejido, 04003 Almería, Spain
Submitted: 12 April 2021 Accepted: 07 May 2021
Online publish date: 16 June 2021
Introduction: The aim of this study was to describe the symptomatology and main factors associated with readmission to the Emergency Department (ED) in COVID-19 patients discharged from hospital during the first wave of the pandemic at the San Cecilio University Hospital, Granada, Spain.
Methods: An observational longitudinal study was conducted in a cohort of 441 patients admitted to our hospital with confirmed SARS-CoV-2 polymerase chain reaction (PCR) from 1 March to 15 April 2020. Patients were followed up through medical records 6 months after discharge. Sociodemographic, clinical and symptomatologic variables were collected. Descriptive, bivariate and multivariate logistic regression analyses were performed.
Results: The mean age of patients in the cohort was 66.4 years (s = 15.3), with 55.1%men. In-hospital mortality was 18.1%. The presence of persistent symptomatology was high (64.5%), especially respiratory (53.2%), systemic (46.3%) and neurological (31.0%). A total of 75 (20.8%) patients were readmitted to the ED during the 6 months following hospital discharge. The main factors associated with readmission to the ED were polymedication (P = 0.031), living in a care home (P = 0.014), fever (P = 0.047), general malaise (P < 0.001), thoracic pain (P < 0.001), headache (P = 0.012), hematological symptoms (P = 0.011), nephrological symptoms (P = 0.047), depressive symptoms (P = 0.009), syncope or hypotension (P = 0.006) and superinfection (P = 0.018). After multivariate adjustment analysis, thoracic pain (OR: 4.45, 95% CI: 1.88–10.52), general malaise and hematological symptoms (OR: 3.95, 95% CI: 1.12–13.89) remained as risk factors.
Conclusions: The presence of persistent symptomatology after hospital discharge in our cohort was common and varied. Polymedication and living in a care home made up the most vulnerable profile of COVID-19 patients for returning to the ED. Thoracic pain, general malaise and hematological symptoms were identified as potential markers of severity, along with others predictors. These findings might be useful for optimizing follow-up strategies. Future studies conducted in other geographical areas are necessary to corroborate our results.
COVID-19; Symptoms; Emergency; Hospitalization; Post-discharge
Álvaro Romero-Duarte,Mario Rivera-Izquierdo,Antonio Jesús Láinez-Ramos-Bossini,Pablo Redruello-Guerrero,Antonio Cárdenas-Cruz. Factors associated with readmission to the Emergency Department in a cohort of COVID-19 hospitalized patients. Signa Vitae. 2021.doi:10.22514/sv.2021.106.
 Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020; 395: 565–574.
 Phan LT, Nguyen TV, Luong QC, Nguyen TV, Nguyen HT, Le HQ, et al. Importation and Human-to-Human Transmission of a Novel Coronavirus in Vietnam. New England Journal of Medicine. 2020; 382: 872–874.
 Holshue ML, DeBolt C, Lindquist S, Lofy KH, Wiesman J, Bruce H, et al. First Case of 2019 Novel Coronavirus in the United States. New England Journal of Medicine. 2020; 382: 929–936.
 Rivera-Izquierdo M, Valero-Ubierna MC, R-delAmo JL, Fernández-García MA, Martínez-Diz S, Tahery-Mahmoud A, et al. Sociode-mographic, clinical and laboratory factors on admission associated with COVID-19 mortality in hospitalized patients: A retrospective observational study. PLoS ONE. 2020; 15: e0235107.
 Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. New England Journal of Medicine. 2020; 382: 1708–1720.
 Zheng Z, Peng F, Xu B, Zhao J, Liu H, Peng J, et al. Risk factors of critical & mortal COVID-19 cases: a systematic literature review and meta-analysis. Journal of Infection. 2020; 81: e16–e25.
 Izcovich A, Ragusa MA, Tortosa F, Lavena Marcio MA, Agnoletti C, Bengolea A, et al. Prognostic factors for severity and mortality in patients infected with COVID-19: A systematic review. PLoS ONE. 2020; 15: e0241955.
 Rivera-Izquierdo M, Valero-Ubierna MDC, R-delAmo JL, Fernández-García MA, Martínez-Diz S, Tahery-Mahmoud A, et al. Therapeutic agents tested in 238 COVID-19 hospitalized patients and their relation-ship with mortality Medicina ClíNica. 2020; 155: 375–381.
 Garrigues E, Janvier P, Kherabi Y, Le Bot A, Hamon A, Gouze H, et al. Post-discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19. Journal of Infection. 2020; 81: e4–e6.
 Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Easton A, et al. Neurological associations of COVID-19. Lancet Neurology. 2020; 19: 767–783.
 Carod Artal FJ. Complicaciones neurológicas por coronavirus y COVID- 19. Revista De Neurología. 2020; 70: 311–322.
 Bridwell R, Long B, Gottlieb M. Neurologic complications of COVID- 19. American Journal of Emergency Medicine. 2020; 38: 1549.e3–1549.e7.
 Kochi AN, Tagliari AP, Forleo GB, Fassini GM, Tondo C. Cardiac and arrhythmic complications in patients with COVID‐19. Journal of Cardiovascular Electrophysiology. 2020; 31: 1003–1008.
 Inciardi RM, Lupi L, Zaccone G, Italia L, Raffo M, Tomasoni D, et al. Cardiac Involvement in a Patient with Coronavirus Disease 2019 (COVID-19). Journal of the American Medical Association Cardiology. 2020; 5: 819–824.
 Haimei M. Pathogenesis and Treatment Strategies of COVID-19-Related Hypercoagulant and Thrombotic Complications. Clinical and Applied Thrombosis/Hemostasis. 2020; 26: 107602962094449.
 Huang C, Huang L, Wang Y, Li X, Ren L, Gu X, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet. 2021; 397: 220–232.
 Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting Characteristics, Comorbidities, and Outcomes among 5700 Patients Hospitalized with COVID-19 in the New York City Area. Journal of the American Medical Association. 2020; 323: 2052–2059.
 Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; 395: 1054–1062.
 Somani SS, Richter F, Fuster V, De Freitas JK, Naik N, Sigel K, et al. Characterization of Patients who Return to Hospital Following Discharge from Hospitalization for COVID-19. Journal of General Internal Medicine. 2020; 35: 2838–2844.
 Kilaru AS, Lee K, Snider CK, Meisel ZF, Asch DA, Mitra N, et al. Return Hospital Admissions among 1419 COVID‐19 Patients Discharged from Five U.S. Emergency Departments. Academic Emergency Medicine. 2020; 27: 1039–1042.
 Identificadas las principales manifestaciones en la piel de la COVID-19. British Journal of Dermatology. 2020; 183: e17.
 Wambier CG, Vaño-Galván S, McCoy J, Gomez-Zubiaur A, Herrera S, Hermosa-Gelbard A, et al. Androgenetic alopecia present in the majority of patients hospitalized with COVID-19: the “Gabrin sign”. Journal of the American Academy of Dermatology. 2020; 83: 680–682.
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.
IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.
Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.
Scopus: CiteScore 0.5(2019) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.