Background and importance 

The outbreak of COVID-19 challenged the global health system and specifically impacted the emergency departments (EDs). Studying the quality indicators of ED care under COVID-19 has been a necessary task, and ED revisits have been used as an indicator to monitor ED performance.

Objectives 

The study investigated whether discrepancies existed among ED revisiting cases before and after COVID-19 and whether the COVID-19 epidemic was a predictor of poor outcomes of ED revisits.

Design 

Retrospective study.

Settings and participants 

We used electronic health records data from a tertiary medical center. Data of patients with 72-h ED revisit after the COVID-19 epidemic were collected from February 2020 to June 2020 and compared with those of patients before COVID-19, from February 2019 to June 2019.

Outcome measures and analysis 

The investigated outcomes included hospital admission, ICU admission, out-of-hospital cardiac arrest, and subsequent inhospital mortality. Univariate and multivariate logistic regression models were used to identify independent predictors of 72-h ED revisit outcomes.

Main results 

In total, 1786 patients were enrolled in our study – 765 in the COVID group and 1021 in the non-COVID group. Compared with the non-COVID group, patients in the COVID group were younger (53.9 vs. 56.1 years old; P = 0.002) and more often female (66.1% vs. 47.3%; P < 0.001) and had less escalation of triage level (11.6% vs. 15.0%; P = 0.041). The hospital admission and inhospital mortality rates in the COVID and non-COVID groups were 33.9% vs. 32.0% and 2.7% vs. 1.5%, respectively. In the logistic regression model, the COVID-19 period was significantly associated with inhospital mortality (adjusted odds ratio, 2.289; 95% confidence interval, 1.059–4.948; P = 0.035).

Conclusion 

Patients with 72-h ED revisits showed distinct demographic and clinical patterns before and after the COVID-19 epidemic; the COVID-19 period was an independent predictor of increased inhospital mortality.

中文翻译：

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2019冠状病毒病流行前后急诊科回访患者结局比较

背景和重要性 

COVID-19 的爆发对全球卫生系统提出了挑战，尤其是对急诊科 (ED) 造成了影响。研究 COVID-19 下 ED 护理的质量指标是一项必要的任务，ED 重访已被用作监测 ED 性能的指标。

目标 

该研究调查了 COVID-19 前后急诊复诊病例之间是否存在差异，以及 COVID-19 流行病是否预示着急诊复诊结果不佳。

设计 

回顾性研究。

设置和参与者 

我们使用了来自三级医疗中心的电子健康记录数据。收集了 2020 年 2 月至 2020 年 6 月 COVID-19 流行后 72 小时 ED 复诊患者的数据，并与 2019 年 2 月至 2019 年 6 月 COVID-19 之前患者的数据进行了比较。

结果测量和分析 

调查结果包括入院、入住 ICU、院外心脏骤停和随后的院内死亡率。单变量和多变量逻辑回归模型用于确定 72 小时 ED 重访结果的独立预测因子。

主要结果 

总共有 1786 名患者参加了我们的研究——COVID 组 765 名，非 COVID 组 1021 名。与非 COVID 组相比，COVID 组患者更年轻（53.9 岁 vs. 56.1 岁；P = 0.002）且女性更多（66.1% vs. 47.3%；P < 0.001）并且分诊级别升级较少（11.6% 与 15.0%；P = 0.041）。COVID 组和非 COVID 组的住院死亡率和住院死亡率分别为 33.9% 对 32.0% 和 2.7% 对 1.5%。在逻辑回归模型中，COVID-19 时期与院内死亡率显着相关（调整后的优势比为 2.289；95% 置信区间为 1.059–4.948；P = 0.035）。

结论 

72 小时急诊复诊的患者在 COVID-19 流行前后表现出明显的人口统计学和临床​​模式；COVID-19 时期是院内死亡率增加的独立预测因素。