Discharge from the emergency department and early hospital revaluation in patients with COVID-19 pneumonia: a prospective study

Abstract

Objective The national health systems are currently facing the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. We assessed the efficacy of outpatient management for patients with SARS-CoV-2 related pneumonia at risk of progression after discharge from the emergency department. Methods This was a single-center prospective study. We enrolled patients with confirmed SARS-CoV-2 pneumonia, without hypoxemic respiratory failure, and at least one of the following: age ≥65 years or the presence of relevant comorbidities or pneumonia extension >25% on high resolution computed tomography. Patients with pneumonia extension >50% were excluded. An ambulatory visit was performed after at least 48 hours, when patients were either discharged, admitted, or deferred for a further visit. As a control, we evaluated a comparable historical cohort of hospitalized patients. Results A total of 84 patients were enrolled (51 male patients; mean age, 62.8 years). Two-thirds of the patients had at least one comorbidity and 41.6% had a lung involvement >25% on high resolution computed tomography; the mean duration of symptoms was 8.0±3.0 days, and the mean PaO2/FiO2 ratio was 357.5±38.6. At the end of the follow-up period, 69 patients had been discharged, and 15 were hospitalized (mean stay of 6 days). Older age and higher National Early Warning Score 2 were significant predictors of hospitalization at the first follow-up visit. One hospitalized patient died of septic shock. In the control group, the mean hospital stay was 8 days. Conclusion Adopting a “discharge and early revaluation” strategy appears to be safe, feasible, and may optimize hospital resources during the SARS-CoV-2 pandemic.

Keywords

• covid-19
• pneumonia
• outpatients
• hospital emergency service