Characterisation of 22446 patients attending UK emergency departments with suspected COVID-19 infection: Observational cohort study

  1. The PRIEST Research Group (details in Appendix 1)
  2. Steve Goodacre
  3. Ben Thomas
  4. Ellen Lee
  5. Laura Sutton
  6. Amanda Loban
  7. Simon Waterhouse
  8. Richard Simmonds
  9. Katie Biggs
  10. Carl Marincowitz
  11. Jose Schutter
  12. Sarah Connelly
  13. Elena Sheldon
  14. Jamie Hall
  15. Emma Young
  16. Andrew Bentley
  17. Kirsty Challen
  18. Chris Fitzimmons
  19. Tim Harris
  20. Fiona Lecky
  21. Andrew Lee
  22. Ian Maconochie
  23. Darren Walter
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Abstract

Background

Hospital emergency departments play a crucial role in the Initial management of suspected COVID-19 infection. We aimed to characterise patients attending emergency departments with suspected COVID-19, including subgroups based on sex, ethnicity and COVID-19 test results.

Methods

We undertook a mixed prospective and retrospective observational cohort study in 70 emergency departments across the United Kingdom (UK). We collected presenting data from 22446 people attending with suspected COVID-19 between 26 March 2020 and 28 May 2020. Outcomes were admission to hospital, COVID-19 result, organ support (respiratory, cardiovascular or renal), and death, by record review at 30 days.

Results

Adults were acutely unwell (median NEWS2 score 4) and had high rates of admission (67.1%), COVID-19 positivity (31.2%), organ support (9.8%) and death (15.9%). Children had much lower rates of admission (27.4%), COVID-19 positivity (1.2%), organ support (1.4%) and death (0.3%). Adult men and women presented in similar numbers (10210 versus 10506), but men were more likely to be admitted (72.9% v 61.4%), require organ support (12.2% v 7.7%) and die (18.7% v 13.3%). Black or Asian adults tended to be younger than White adults (median age 54, 50 and 67 years), were less likely to be admitted (60.8%, 57.3%, 69.6%) or die (11.9%, 11.2%, 16.8%), but were more likely to require organ support (15.9%, 14.3%, 8.9%) or have a positive COVID-19 test (40.8%, 42.1%, 30.0%). Adults admitted with confirmed COVID-19 had similar age and comorbidities (except chronic lung disease) to those who did not have COVID-19 confirmed, but were much more likely to need organ support (22.2% v 8.9%) or die (32.7% v 15.9%).

Conclusions

Important differences exist between patient groups presenting to the emergency department with suspected COVID-19. People with confirmed COVID-19 have a poor prognosis, compared with similar emergency admissions without confirmed COVID-19.

Registration

ISRCTN registry, <ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="isrctn" xlink:href="56149622">ISRCTN56149622</ext-link>, <ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://www.isrctn.com/ISRCTN28342533">http://www.isrctn.com/ISRCTN28342533</ext-link>

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