PHILADELPHIA — A new study focusing on Philadelphia-area hospitals during the early months of the coronavirus pandemic comes to a concerning conclusion. Researchers at UPenn’s Perelman School of Medicine conclude that roughly one in 10 COVID-19 patients discharged from the ER during that period had to return to the hospital for more treatment within just one week.
Many patients who had to return to the hospital displayed a fever and or lower pulse oximetry levels. Needless to say, researchers believe their findings here may prove invaluable for countless hospitals across the world.
“We hope this study helps emergency clinicians have more informed conversations with patients suspected to have COVID-19,” says lead study author Austin Kilaru, MD, an Emergency Medicine physician at Penn Medicine, in a release. “It can be difficult to make this diagnosis and send patients home without knowing if they will get sick in the coming days. This study gives clinicians a few signposts to know how often and when patients may need to return, and what risk factors to pay attention to.”
Readmission rate ‘twice that of other illnesses’
A total of 1,419 patients who entered a Philadelphia emergency department between March 1st and May 28th, were eventually discharged, and had tested positive for COVID-19 within seven days of that hospital visit, were included in this study. In all, 4.7% of those patients were officially re-admitted to their hospital within just three days of their first visit. Another 3.9 were re-hospitalized within a week. In total, that works out to 8.6% of all included patients returning for more treatment after being released.
“We were surprised with the overall rate that patients return and need admission, which is twice that of other illnesses,” Kilaru explains. “The concern is not that emergency physicians are making wrong decisions, but rather that COVID can be unpredictable and turn severe rather quickly.”
Older COVID patients, those with fever most likely to return
As has been a running theme with the coronavirus, older patients (over the age of 60) appear to be at an elevated risk of hospital re-admittance. In comparison to patients aged 18 through 39 years old, those aged 60 or older were over five times as likely to need more hospitalization after a discharge. Adults aged between 40 and 59 were three times as likely.
Regardless of age, however, if a patient displayed low pulse oximetry readings they were roughly four times as likely to require another hospital stay. Similarly, patients with a fever were over three times as likely to be re-admitted than patients with no fever.
“If the patient had other factors such as an abnormal chest x-ray, the likelihood of needing to come back to be hospitalized goes up even more,” adds senior study author, M. Kit Delgado, MD, an assistant professor of Emergency Medicine and Epidemiology.
It’s also of note that racial and gender differences didn’t seem to influence chances of hospital re-admittance.
“This further contributes to the evidence that the known racial disparities in COVID mortality are not related to differences in care and outcomes among patients once treated in the same hospital system. Rather, the disparities are structural related to the higher rates of infection and access to care in low-income communities, which are disproportionately Black and Hispanic,” Dr. Delgado comments.
The study is published in Academic Emergency Medicine.