Evaluation of triage checklist for mild COVID-19 outpatients in predicting subsequent emergency department visits and hospitalization during isolation period

  1. Yasuhiro Tanaka
  2. Kazuko Yamamoto
  3. Shimpei Morimoto
  4. Takeshi Nabeshima
  5. Kayoko Matsushima
  6. Hiroshi Ishimoto
  7. Nobuyuki Ashizawa
  8. Tatsuro Hirayama
  9. Kazuaki Takeda
  10. Hiroshi Gyotoku
  11. Naoki Iwanaga
  12. Shinnosuke Takemoto
  13. Susumu Fukahori
  14. Takahiro Takazono
  15. Hiroyuki Yamaguchi
  16. Takashi Kido
  17. Noriho Sakamoto
  18. Naoki Hosogaya
  19. Shogo Akabame
  20. Takashi Sugimoto
  21. Hirotomo Yamanashi
  22. Kosuke Matsui
  23. Mai Izumida
  24. Ayumi Fujita
  25. Masato Tashiro
  26. Takeshi Tanaka
  27. Koya Ariyoshi
  28. Akitsugu Furumoto
  29. Kouichi Morita
  30. Koichi Izumikawa
  31. Katsunori Yanagihara
  32. Hiroshi Mukae
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Abstract

Background and objective

Limited evidence exists regarding the outcomes of patients with coronavirus disease 2019 (COVID-19) who are not hospitalized. This study aimed to assess the outcomes for mild COVID-19 patients in terms of emergency department (ED) visits and hospital admission given initial outpatient triage evaluation and to identify the triage factors affecting these outcomes.

Methods

This retrospective cohort study investigated adult COVID-19 Japanese patients who were triaged at Nagasaki University Hospital between April 1, 2021, and May 31, 2021. A triage checklist with 30 factors was used to identify patients requiring hospitalization. Patients recommended for isolation were followed up for later ED visit or hospital admission.

Results

Overall, 338 COVID-19 patients (mean age, 44.7; 45% women) visited the clinic at an average of 5.4 days after symptom onset. Thirty-six patients (10.6%) were hospitalized from triage, and the rest were recommended for isolation. Seventy-two non-hospitalized patients (23.8%) visited ED during their isolation period, and 30 (9.9%) were hospitalized after ED evaluation. The mean duration to ED visit and hospitalization after symptom onset were 8.8 and 9.7 days, respectively. Checklist factors associated with hospitalization during the isolation period were age > 50 years, obesity with BMI > 25, underlying hypertension, tachycardia with HR > 100/min or blood pressure >135 mmHg at triage, and >□3-day delay in hospital visit after symptom onset.

Conclusion

Clinicians should be wary of COVID-19 patients with above risk factors and prompt them to seek follow-up assessment by a medical professional.

SUMMARY AT A GLANCE

Overall, 338 patients with mild COVID-19 were retrospectively followed up. Factors such as age >□50 years, BMI□> □25, underlying hypertension, high blood pressure and tachycardia at triage, and delayed visit after symptom onset were associated with emergency department visit and hospitalization during the isolation period.

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