A modified emergency severity index level is associated with outcomes in cancer patients with COVID-19

Abstract

Objective To evaluate a modified emergency severity index (mESI)-based triage of cancer patients with coronavirus disease 2019 (COVID-19) in the emergency department (ED) and determine the associations between mESI level and ED disposition, hospital length of stay, and overall survival. Methods Medical records were retrospectively reviewed for all patients who presented to our institution's ED between March 22, 2020, and March 12, 2021, and tested positive for SARS-CoV-2. Results A total of 306 cancer patients tested positive for SARS-CoV-2, with 45% of patients triaged to level 2 (emergent) and 55% to level 3 (urgent). Among all patients, 61.8% were admitted to the hospital, 15.7% were admitted to the intensive care unit, 2.9% were sent for observation, and 19.6% were discharged. Although demographic and clinical characteristics did not significantly vary by triage level, we observed significant differences in ED length of stay (urgent = 6.67 h, emergent = 5.97 h; p < 0.01). Hospital and intensive care unit admission rates were also significantly higher among emergent patients than among urgent patients ( p < 0.05). There were 75 deaths (urgent = 32; emergent = 43), and the 30-day mortality rate was significantly higher among emergent patients (urgent = 8%, emergent = 15%; p < 0.05). The mESI level persisted as a significant factor associated with overall survival (hazard ratio = 1.7, 95% confidence interval = 1.09–2.81) in multivariable analysis. Conclusion The mESI level is associated with ED disposition, ED length of stay, and overall survival in cancer patients presenting with COVID-19. These results indicate that the mESI triage tool can be effectively used in cancer patients with COVID-19, whose condition can rapidly deteriorate.

La palabra que articula y nombra

“…¿Existe problemas respiratorios o dolor agudo? si la afirmación es positiva se prioriza un nivel de riesgo tipo II de lo contrario, se continúa desarrollando las interrogantes posteriores (Kemp et al, 2022;Lipe et al, 2022). (Lipe et al, 2022).…”

“…Para reconocer de manera concreta el personal encargado de formular el triaje debe corroborar que los valores no sobrepasen el umbral permitido, por ejemplo, en adultos mayores si el nivel de saturación es menor <88% se considera una prioridad tipo III al igual que, si la frecuencia cardíaca es >100 y la frecuencia respiratoria es >20 de igual manera se categoriza dentro de este nivel de prioridad. Para dar por terminada la primera etapa si el paciente presenta valores normales de las constantes corporales y tan solo emplea una mínima cantidad de recursos se lo deriva a un nivel IV y V (Kemp et al, 2022;Lipe et al, 2022).…”

Administración eficiente del capital humano y efectividad institucional de los hospitales.

“…¿Existe problemas respiratorios o dolor agudo? si la afirmación es positiva se prioriza un nivel de riesgo tipo II de lo contrario, se continúa desarrollando las interrogantes posteriores (Kemp et al, 2022;Lipe et al, 2022). (Lipe et al, 2022).…”

Emergency department use by patients who received chimeric antigen receptor T cell infusion therapy

“…Life-threatening is level 1, emergent level 2, urgent level 3, less urgent level 4, and non-urgent level 5. This five-level triage algorithm classifies patients based on disease severity at presentation and the expected resource utilization (12). The "presenting complaint" was defined as the patient's reported reason for visiting the ED at the time of the triage assessment.…”