Comparison of the Clinical Process and Outcomes in Patients after Coronavirus Infection 2019 Outbreak
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Population
2.2. Data Collection and Outcome Measurement
2.3. Statistical Analyses
3. Results
3.1. Baseline Characteristics
3.2. The Distribution of Diagnosis According to the ICD-10 Classification
3.3. Comparison of Time Variables in the Clinical Processes by the Pre- and COVID-19 Period
3.4. Antibiotics Administered during the Pre- and COVID-19 Period
3.5. Predicting Factors for Hospital Admission in Pre- and COVID-19 Periods
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | Pre-COVID-19 Period (n = 931) | COVID-19 Period (n = 749) | p-Value |
---|---|---|---|
Age (y) † | 51.7 ± 23.5 | 53.9 ± 23.3 | 0.048 |
Sex ‡ | 0.311 | ||
Male | 443 (47.6) | 375 (50.1) | |
Female | 488 (52.4) | 374 (49.9) | |
Vital sign † | |||
Systolic blood pressure (mmHg) | 130.4 ± 22.7 | 135.2 ± 26.2 | <0.001 |
Diastolic blood pressure (mmHg) | 75.5 ± 13.1 | 77.7 ± 13.5 | 0.001 |
Pulse rate (beats/min) | 101.1 ± 18.1 | 101 ± 18.4 | 0.880 |
Respiratory rate (breath/min) | 20.5 ± 2.2 | 19.8 ± 1.9 | <0.001 |
Body temperature (°C) | 38.2 ± 0.6 | 38.1 ± 0.5 | 0.004 |
Mental status ‡ | 0.389 | ||
Alert | 906 (97.3) | 721 (96.3) | |
Verbal response | 14 (1.5) | 18 (2.4) | |
Painful response | 11 (1.2) | 10 (1.3) | |
Unresponsive | 0 | 0 | |
KTAS Triage category ‡ | 0.002 | ||
Level 1 Resuscitation | 1 (0.1) | 2 (0.3) | |
Level 2 Emergent | 30 (3.2) | 32 (4.3) | |
Level 3 Urgent | 438 (47.0) | 279 (37.2) | |
Level 4 Less urgent | 453 (48.7) | 427 (57.0) | |
Level 5 Non urgent | 9 (1.0) | 9 (1.2) | |
qSOFA ≥2 ‡ | 23 (2.5) | 26 (3.5) | 0.226 |
ED Disposition ‡ | 0.001 | ||
Discharge ‡ | 599 (64.3) | 421 (56.2) | |
Admission ‡ | 332 (35.7) | 328 (43.8) | |
ICU admission ‡ | 47 (14.2) | 46 (14.0) | 0.961 |
Hospital LOS (d) § | 10 (6.25–18.00) | 10.50 (6.00–20.00) | 0.807 |
In-hospital mortality ‡ | 25 (7.5) | 30 (9.1) | 0.453 |
Diagnosis at Emergency Department Discharge | |||
---|---|---|---|
Pre-COVID-19 Period | COVID-19 Period | ||
(n = 941) | (n = 759) | ||
X Disease of the respiratory system | 316 (33.9) | XVIII Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified | 180 (24.0) |
I Certain infectious and parasitic disease | 166 (17.8) | X Disease of the respiratory system | 140 (18.7) |
XIV Diseases of the genitourinary system | 134 (14.4) | I Certain infectious and parasitic disease | 110 (14.7) |
XVIII Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified | 127 (13.6) | XIV Diseases of the genitourinary system | 101 (13.5) |
XI Diseases of the digestive system | 85 (9.1) | XI Diseases of the digestive system | 74 (9.9) |
II Neoplasm | 26 (2.8) | II Neoplasm | 49 (6.5) |
IX Diseases of the circulatory system | 20 (2.1) | IX Diseases of the circulatory system | 26 (3.5) |
XII Diseases of the skin and subcutaneous tissue | 17 (1.8) | XII Diseases of the skin and subcutaneous tissue | 17 (2.3) |
III Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism | 13 (1.4) | XIII Diseases of the musculoskeletal system and connective tissue | 14 (1.9) |
VI Diseases of the nervous system | 8 (0.9) | XXI Factors influencing health status and contact with health services | 8 (1.1) |
IV Endocrine, nutritional and metabolic diseases | 5 (0.5) | III Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism | 5 (0.7) |
V Mental and behavioral disorders | 4 (0.4) | VI Diseases of the nervous system | 5 (0.7) |
XIX Injury, poisoning and certain other consequences of external causes | 4 (0.4) | IV Endocrine, nutritional and metabolic diseases | 5 (0.7) |
XIII Diseases of the musculoskeletal system and connective tissue | 3 (0.3) | XIX Injury, poisoning and certain other consequences of external causes | 4 (0.5) |
XXI Factors influencing health status and contact with health services | 3 (0.3) | V Mental and behavioral disorders | 3 (0.4) |
VIII Diseases of the ear and mastoid process | 3 (0.4) | ||
VII Diseases of the eye and adnexa | 2 (0.3) | ||
XV Pregnancy, childbirth and the puerperium | 2 (0.3) | ||
XVII Congenital malformations, deformations and chromosomal abnormalities | 1 (0.1) | ||
Diagnosis at Inpatient Discharge | |||
Pre-COVID-19 Period | COVID-19 Period | ||
(n = 332) | (n = 328) | ||
X Diseases of the respiratory system | 78 (23.5) | XI Diseases of the digestive system | 70 (21.3) |
XI Diseases of the digestive system | 72 (21.7) | X Diseases of the respiratory system | 67 (20.4) |
XIV Diseases of the genitourinary system | 62 (18.7) | XIV Diseases of the genitourinary system | 51 (15.5) |
II Neoplasms | 39 (11.7) | II Neoplasms | 35 (10.7) |
I Certain infectious and parasitic diseases | 23 (6.9) | IX Diseases of the circulatory system | 25 (7.6) |
IX Diseases of the circulatory system | 17 (5.1) | XVIII Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified | 21 (6.4) |
III Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism | 8 (2.4) | I Certain infectious and parasitic diseases | 18 (5.5) |
XVIII Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified | 8 (2.4) | III Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism | 11 (3.4) |
IV Endocrine, nutritional and metabolic diseases | 6 (1.8) | XIX Injury, poisoning and certain other consequences of external causes | 7 (2.1) |
XIX Injury, poisoning and certain other consequences of external causes | 6 (1.8) | VI Diseases of the nervous system | 5 (1.5) |
VI Diseases of the nervous system | 4 (1.2) | XII Diseases of the skin and subcutaneous tissue | 5 (1.5) |
XIII Diseases of the musculoskeletal system and connective tissue | 4 (1.2) | XIII Diseases of the musculoskeletal system and connective tissue | 4 (1.2) |
XII Diseases of the skin and subcutaneous tissue | 3 (0.9) | XV Pregnancy, childbirth and the puerperium | 3 (0.9) |
XXI Factors influencing health status and contact with health services | 2 (0.6) | XXI Factors influencing health status and contact with health services | 2 (0.6) |
IV Endocrine, nutritional and metabolic diseases | 1 (0.3) | ||
VII Diseases of the eye and adnexa | 1 (0.3) | ||
VIII Diseases of the ear and mastoid process | 1 (0.3) | ||
XVII Congenital malformations, deformations and chromosomal abnormalities | 1 (0.3) |
Variable | Pre-COVID-19 Period (n = 931) | COVID-19 Period (n = 749) | p-Value |
---|---|---|---|
ED LOS (min) a | 207.7 ± 102.7 | 223.5 ± 119.4 | 0.004 |
Laboratory tests (CBC) † | |||
Door to Order (min) a | 50.8 ± 16.3 | 54 ± 23.2 | 0.003 |
Order to Perform (min) a | 32.2 ± 12.3 | 33.2 ± 17.8 | 0.212 |
Door to Perform (min) | 82.9 ± 26.7 | 87.2 ± 39.2 | 0.018 |
Radiography ‡ | |||
Door to Order (min) a | 54.3 ± 30 | 59.4 ± 38.8 | 0.009 |
Order to Perform (min) a | 32 ± 24.5 | 32.9 ± 25.5 | 0.540 |
Door to Perform (min) | 86.3 ± 50.5 | 92.2 ± 57.6 | 0.047 |
Computed tomography § | |||
Door to Order (min) a | 167.5 ± 70.6 | 165 ± 63 | 0.726 |
Order to Perform (min) a | 40.5 ± 27.8 | 43.8 ± 35.2 | 0.327 |
Door to Perform (min) | 207.9 ± 88.3 | 208.7 ± 89.6 | 0.933 |
Door to Antibiotics (min) ¶,a | 195.8 ± 103.3 | 216.9 ± 108.4 | 0.003 |
Variable | Pre-COVID-19 Period | COVID-19 Period | p-Value |
---|---|---|---|
(n = 931) | (n = 749) | ||
Antibiotics | 0.295 | ||
No | 449 (48.2) | 342 (45.7) | |
Yes | 482 (51.8) | 407 (54.3) | |
0.179 | |||
1st cephalosporin | 11 (2.3) | 13 (3.2) | |
2nd cephalosporin | 6 (1.2) | 2 (0.5) | |
3rd cephalosporin | 109 (22.6) | 111 (27.3) | |
4th cephalosporin | 47 (9.8) | 39 (9.6) | |
Aminoglycosides | 1 (0.2) | 0 | |
Carbapenem | 33 (6.8) | 34 (8.4) | |
Penicillin | 59 (12.2) | 64 (15.7) | |
Quinolone | 214 (44.4) | 142 (34.9) | |
Vancomycin | 2 (0.4) | 2 (0.5) |
Pre-COVID-19 Period | |||
Variable | OR | B | p-Value |
Age (years) | 1.040 (1.025–1.054) | 0.039 | <0.001 |
Sex; Male | 2.011 (1.197–3.376) | 0.698 | 0.008 |
KTAS triage category ≤ 3 | 2.808 (1.646–4.791) | 1.033 | <0.001 |
ED LOS (min) | 1.007 (1.004–1.011) | 0.007 | <0.001 |
Radiography | |||
Door to Perform (min) | 1.006 (1.000–1.011) | 0.006 | 0.034 |
COVID-19 Period | |||
Variable | OR | B | p-Value |
Age (years) | 1.036 (1.022–1.050) | 0.035 | <0.001 |
Respiratory rate (breath/min) | 1.318 (1.122–1.548) | 0.276 | 0.001 |
KTAS triage category ≤ 3 | 2.098 (1.205–3.654) | 0.741 | 0.009 |
ED LOS (min) | 1.003 (1.000–1.006) | 0.003 | 0.037 |
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Bae, S.-J.; Chung, H.-S.; Namgung, M.; Choi, Y.-H.; Min, J.-H.; Lee, D.-H. Comparison of the Clinical Process and Outcomes in Patients after Coronavirus Infection 2019 Outbreak. Medicina 2021, 57, 1086. https://doi.org/10.3390/medicina57101086
Bae S-J, Chung H-S, Namgung M, Choi Y-H, Min J-H, Lee D-H. Comparison of the Clinical Process and Outcomes in Patients after Coronavirus Infection 2019 Outbreak. Medicina. 2021; 57(10):1086. https://doi.org/10.3390/medicina57101086
Chicago/Turabian StyleBae, Sung-Jin, Ho-Sub Chung, Myeong Namgung, Yoon-Hee Choi, Jin-Hong Min, and Dong-Hoon Lee. 2021. "Comparison of the Clinical Process and Outcomes in Patients after Coronavirus Infection 2019 Outbreak" Medicina 57, no. 10: 1086. https://doi.org/10.3390/medicina57101086