Characterisation of 22445 patients attending UK emergency departments with suspected COVID-19 infection: Observational cohort study
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Abstract
Background: Hospital emergency departments play a crucial role in the initial assessment and management of suspected COVID-19 infection. This needs to be guided by studies of people presenting with suspected COVID-19, including those admitted and discharged, and those who do not ultimately have COVID-19 confirmed. We aimed to characterise patients attending emergency departments with suspected COVID-19, including subgroups based on sex, ethnicity and COVID-19 test results. Methods and findings: We undertook a mixed prospective and retrospective observational cohort study in 70 emergency departments across the United Kingdom (UK). We collected presenting data from 22445 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. Mean age was 58.4 years, 11200 (50.4%) were female and 11034 (49.6%) male. Adults (age >16 years) were acutely unwell (median NEWS2 score of 4), frequently had limited performance status (46.9%) and had high rates of admission (67.1%), COVID-19 positivity (31.2%), organ support (9.8%) and death (15.5%). Children had much lower rates of admission (27.4%), COVID-19 positivity (1.2%), organ support (1.4%) and death (0.3%). Similar numbers of men and women presented to the ED, but men were more likely to be admitted (72.9% v 61.4%), require organ support (12.2% v 7.7%) and die (18.2% v 13.0%). Black or Asian adults tended to be younger than White adults (median age 54, 50 and 67 years), were less likely to have impaired performance status (43.1%, 26.8% and 51.6%), be admitted to hospital (60.8%, 57.3%, 69.6%) or die (11.6%, 11.2%, 16.4%), 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 suspected and confirmed COVID-19 had similar age, performance status 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 (32.1% v 15.5%). Conclusions: Important differences exist between patient groups presenting to the emergency department with suspected COVID-19. Adults and children differ markedly and require different approaches to emergency triage. Admission and adverse outcome rates among adults suggest that policies to avoid unnecessary ED attendance achieved their aim. Subsequent COVID-19 confirmation confers a worse prognosis and greater need for organ support. Registration: ISRCTN registry, ISRCTN56149622, http://www.isrctn.com/ISRCTN28342533 .
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Children with suspected COVID-19 had very low rates of confirmed COVID-19 or adverse outcome.
“We also only included adults (age ≥ 16 years) because previous analysis15 showed that children with suspected COVID-19 had very low rates of confirmed COVID-19 or adverse outcome.”
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- Authors
- Goodacre, S., Thomas, B., Lee, E., Sutton, L., Loban, A., Waterhouse, S., Simmonds, R., Biggs, K., Marincowitz, C., Schutter, J., Connelly, S., Sheldon, E., Hall, J., Young, E., Bentley, A., Challen, K., Fitzsimmons, C., Harris, T., Lecky, F., Lee, A., Maconochie, I., & Walter, D.
- Affiliations
- University of Sheffield (GB)
- Manchester University NHS Foundation Trust (GB)
- Lancashire Teaching Hospitals NHS Foundation Trust (GB)
- Sheffield Children's NHS Foundation Trust (GB)
- Barts Health NHS Trust (GB)
- Imperial College Healthcare NHS Trust (GB)
- Corresponding author
- Goodacre, Steve
- Thomas, Ben
- Lee, Ellen
- Sutton, Laura
- Loban, Amanda
- Waterhouse, Simon
- Simmonds, Richard
- Biggs, Katie
- Marincowitz, Carl
- Connelly, Sarah
- Sheldon, Elena
- Hall, Jamie
- Young, Emma
- Bentley, Andrew
- Challen, Kirsty
- Fitzsimmons, Chris
- Harris, Tim
- Lecky, Fiona
- Lee, Andrew
- Maconochie, Ian
- Walter, Darren
- ORCID
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2020-11-25
- Volume
- 15
- Issue
- 11
- Pages
- e0240206
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC7688143
- OpenAlex
- W3110518214
- Cited by
- 30
- References
- 18
- Citations by year
- 2024: 1 · 2023: 6 · 2022: 10 · 2021: 13
- FWCI
- 0.95
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- medRxiv (acceptedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Research Explorer (The University of Manchester) (submittedVersion, cc-by)
- Funders
- Health Technology Assessment Programme (11/46/07)
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Keywords
- COVID-19 pandemic, emergency department presentation, suspected COVID-19, hospitalization, organ support, mortality, sex differences, ethnicity, children, performance status, NEWS2 score, SARS-CoV-2, United Kingdom, emergency department utilization, resource allocation, health disparities, pediatric emergency department, children's hospitals
- MeSH terms
- COVID-19, SARS-CoV-2, Age Factors, Aged, Child, Child, Preschool, Emergency Service, Hospital, Female, United Kingdom, Humans, Infant, Infant, Newborn, Male, Middle Aged, Patient Admission, Prospective Studies, Retrospective Studies, Triage, Comorbidity, Pandemics
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