Epidemiology and clinical features of emergency department patients with suspected and confirmedCOVID‐19: A multisite report from theCOVID‐19 Emergency DepartmentQuality Improvement Project for July 2020 (COVED‐3)

Abstract

Objective The aim of this study was to describe the epidemiology and clinical features of patients presenting to the emergency department (ED) with suspected and confirmed COVID‐19. Methods The COVID‐19 Emergency Department (COVED) Project is an ongoing prospective cohort study in Australian EDs. This analysis presents data from eight sites across Victoria and Tasmania for July 2020 (during Australia's ‘second wave’). All adult patients who met criteria for ‘suspected COVID‐19’ and underwent testing for SARS‐CoV‐2 in the ED were eligible for inclusion. Study outcomes included a positive SARS‐CoV‐2 test result and mechanical ventilation. Results In the period 1 to 31 July 2020, there were 30 378 presentations to the participating EDs and 2917 (9.6%; 95% CI: 9.3–9.9) underwent testing for SARS‐CoV‐2. Of these, 50 (2%) patients returned a positive result. Among positive cases, two (4%) received mechanical ventilation during their hospital admission compared to 45 (2%) of the SARS‐CoV‐2 negative patients (OR 1.7 [95% CI: 0.4–7.3], p = 0.47). Two (4%) SARS‐CoV‐2 positive patients died in hospital compared to 46 (2%) of the SARS‐CoV‐2 negative patients (OR 1.7 [0.4–7.1] p = 0.49). Strong clinical predictors of a positive result included self‐reported fever, non‐smoking status, bilateral infiltrates on CXR, and absence of a leucocytosis on first ED blood tests (p < 0.05). Conclusions In this prospective multi‐site study from July 2020, a substantial proportion of ED patients required SARS‐CoV‐2 testing, isolation and enhanced infection prevention and control precautions. Presence of SARS‐CoV‐2 on nasopharyngeal swab was not associated with death or mechanical ventilation. This article is protected by copyright. All rights reserved.

Epidemiology and clinical features of emergency department patients with suspected COVID‐19: Insights from Australia's ‘second wave’ (COVED‐4)

“…The epidemiological and clinical predictors of a positive SARS‐CoV‐2 test identified in the present study are generally consistent with the findings of COVED‐3 2 . Not surprisingly, contact with a confirmed case and a recent positive SARS‐CoV‐2 test are very strong risk factors for a diagnosis of COVID‐19.…”

“…Summary descriptive statistics have been determined for each pre‐specified variable; these data have been stratified by the test result for the SARS‐CoV‐2 PCR swab taken in the ED. As for COVED‐3, 2 there were sufficient SARS‐CoV‐2 positive cases to undertake inferential analyses (comparing predictors and outcomes by SARS‐CoV‐2 test result, with summary measures of association and 95% confidence intervals [CIs]). Symmetrical numerical data have been summarised using the mean and standard deviation; skewed and ordinal data have been summarised using the median and interquartile range; and categorical data have been summarised using the frequency and percentage.…”

“…Despite the significant decline in community transmission, 1 a substantial proportion of Australian ED patients continue to meet criteria for ‘suspected COVID‐19’ and therefore require isolation and testing 2 . This has led to a number of issues for EDs, particularly in terms of maintaining ‘business as usual’ in parallel with rigorous infection prevention and control (IPC) for suspected and confirmed cases 3 .…”

“…COVED‐3 reported data across eight EDs during July 2020, and revealed no difference in the rates of mechanical ventilation and in‐hospital death between SARS‐CoV‐2 positive and negative patients. The main clinical predictors of a COVID‐19 diagnosis were subjective fever, bilateral infiltrates on chest X‐ray (CXR), non‐smoking status and absence of leucocytosis 2 …”

A national system for monitoring intensive care unit demand and capacity: the Critical Health Resources Information System (CHRIS)

“…After a decline in severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infections throughout Australia, notifications rose again in Melbourne at the end of June 2020 8 . In response, ICU directors from the lead hospitals of the nine designated Victorian health care clusters commenced a daily morning meeting with representatives from Ambulance Victoria, Safer Care Victoria and the Victorian Department of Health and Human Services.…”