Predicting hospital readmission and 90-day mortality in patients presenting at the emergency department during the first COVID-19 wave in Belgium

Abstract

Background: During the early stages of the COVID-19 pandemic, emergency departments (EDs) faced large numbers of patients suspected to be infected with a new pathogen for which no guidelines existed. The emergency physician’s gestalt was appealed to more than ever to prevent health care system breakdown.

Methods: This retrospective observational study analyzed the data from the first COVID-19 wave in a nonacademic tertiary hospital in Belgium to identify risk factors for mortality and ED readmission rates. Second, the performance of the physicians’ gestalt was assessed. The main outcome measures were the hospital readmission rate within 90 days and mortality rate at 90 days in patients who presented with suspected COVID-19 symptoms at our ED and were discharged according to the attending physician’s gestalt.

Main results: A total of 2140 patients presented to the ED for suspected COVID-19 symptoms. A total of 1163 patients were discharged home the same day. 12/1163 (1.03%) died within 90 days after initial discharge from the ED. Age was the main risk factor for mortality after discharge. 298/1163 (25.6%) patients needed hospital readmission within 90 days after initial discharge from the ED. Lower hemoglobin and C-reactive protein (CRP) are associated with a higher risk of readmission.

Conclusions: When facing an unknown and overwhelming pandemic, the physician’s gestalt could be an important and reliable tool to guide clinical practice in the ED. Older patients and patients with low hemoglobin and CRP should warrant close follow-up after discharge from the ED for respiratory problems, as they are at risk for mortality and readmission, respectively.