Recent reports of patients with coronavirus disease 2019 (COVID-19) developing pneumothorax correspond mainly to case reports describing mechanically ventilated patients. The real incidence, clinical ...characteristics, and outcome of spontaneous pneumothorax (SP) as a form of COVID-19 presentation remain to be defined.
Do the incidence, risk factors, clinical characteristics, and outcomes of SP in patients with COVID-19 attending EDs differ compared with COVID-19 patients without SP and non-COVID-19 patients with SP?
This case-control study retrospectively reviewed all patients with COVID-19 diagnosed with SP (case group) in 61 Spanish EDs (20% of Spanish EDs) and compared them with two control groups: COVID-19 patients without SP and non-COVID-19 patients with SP. The relative frequencies of SP were estimated in COVID-19 and non-COVID-19 patients in the ED, and annual standardized incidences were estimated for both populations. Comparisons between case subjects and control subjects included 52 clinical, analytical, and radiologic characteristics and four outcomes.
We identified 40 occurrences of SP in 71,904 patients with COVID-19 attending EDs (0.56‰; 95% CI, 0.40‰-0.76‰). This relative frequency was higher than that among non-COVID-19 patients (387 of 1,358,134, 0.28‰; 95% CI, 0.26‰-0.32‰; OR, 1.93; 95% CI, 1.41-2.71). The standardized incidence of SP was also higher in patients with COVID-19 (34.2 vs 8.2/100,000/year; OR, 4.19; 95% CI, 3.64-4.81). Compared with COVID-19 patients without SP, COVID-19 patients developing SP more frequently had dyspnea and chest pain, low pulse oximetry readings, tachypnea, and increased leukocyte count. Compared with non-COVID-19 patients with SP, case subjects differed in 19 clinical variables, the most prominent being a higher frequency of dysgeusia/anosmia, headache, diarrhea, fever, and lymphopenia (all with OR > 10). All the outcomes measured, including in-hospital death, were worse in case subjects than in both control groups.
SP as a form of COVID-19 presentation at the ED is unusual (< 1‰ cases) but is more frequent than in the non-COVID-19 population and could be associated with worse outcomes than SP in non-COVID-19 patients and COVID-19 patients without SP.
Objective
We investigated the incidence, predictor variables, clinical characteristics, and stroke outcomes in patients with COVID‐19 seen in emergency departments (EDs) before hospitalization.
...Methods
We retrospectively reviewed all COVID‐19 patients diagnosed with stroke during the COVID‐19 outbreak in 62 Spanish EDs. We formed two control groups: COVID‐19 patients without stroke (control A) and non–COVID‐19 patients with stroke (control B). We compared disease characteristics and four outcomes between cases and controls.
Results
We identified 147 strokes in 74,814 patients with COVID‐19 seen in EDs (1.96‰, 95% confidence interval CI = 1.66‰ to 2.31‰), being lower than in non–COVID‐19 patients (6,541/1,388,879, 4.71‰, 95% CI = 4.60‰ to 4.83‰; odds ratio OR = 0.42, 95% CI = 0.35 to 0.49). The estimated that standardized incidences of stroke per 100,000 individuals per year were 124 and 133 for COVID‐19 and non–COVID‐19 individuals, respectively (OR = 0.93 for COVID patients, 95% CI = 0.87 to 0.99). Baseline characteristics associated with a higher risk of stroke in COVID‐19 patients were hypertension, diabetes mellitus, and previous cerebrovascular and coronary diseases. Clinically, these patients more frequently presented with confusion, decreased consciousness, and syncope and higher D‐dimer concentrations and leukocyte count at ED arrival. After adjustment for age and sex, the case group had higher hospitalization and intensive care unit (ICU) admission rates (but not mortality) than COVID‐19 controls without stroke (OR = 3.41, 95% CI = 1.27 to 9.16; and OR = 3.79, 95% CI = 1.69 to 8.50, respectively) and longer hospitalization and greater in‐hospital mortality than stroke controls without COVID‐19 (OR = 1.55, 95% CI = 1.24 to 1.94; and OR = 1.77, 95% CI = 1.37 to 2.30, respectively).
Conclusions
The incidence of stroke in COVID‐19 patients presenting to EDs was lower than that in the non–COVID‐19 reference sample. COVID‐19 patients with stroke had greater need for hospitalization and ICU admission than those without stroke and longer hospitalization and greater in‐hospital mortality than non–COVID‐19 patients with stroke.
Background: The early stages of the COVID-19 pandemic overwhelmed general hospitals in Spain. In response, a dedicated hospital for COVID-19 care, the Hospital de Emergencias Enfermera Isabel Zendal ...(HEEIZ), was established. This study aimed to compare clinical outcomes of COVID-19 patients treated at the specialized HEEIZ with those at conventional general hospitals (CGHs) in Madrid, Spain. Methods: The study was a prospective, observational cohort study including COVID-19 patients admitted to the HEEIZ and 14 CGHs (December 2020 to August 2021). Patients were assigned based on hospital preference. Clinical data were collected and analyzed using multivariate regression to assess primary and secondary outcomes, including hospital mortality, need of invasive mechanical ventilation (IMV), and pharmacological treatments. Results: The HEEIZ cohort (n = 2997) was younger and had lower Charlson comorbidity scores than the CGH cohort (n = 1526). Adjusted HEEIZ hospital mortality was not significantly higher compared with CGHs (OR: 1.274; 95% CI: 0.781–2.079; p = 0.332). Conclusions: During the study period, patients admitted to the HEEIZ showed no significant differences in clinical outcomes, compared with patients admitted at CGHs. These results might support the use of specialized centers in managing pandemic surges, allowing CGHs to handle other needs.
To compare the ability of 3 frailty scales (the Clinical Frailty Scale CFS, the Functional Index - eMergency FIM, and the Identification of Seniors at Risk ISAR scale) to predict adverse outcomes at ...30 days in older patients discharged from hospital emergency departments (EDs).
Secondary analysis of data from the FRAIL-Madrid registry of patients aged 75 years or older who were discharged from Madrid EDs over a period of 3 months in 2018 and 2019. Frailty was defined by a CFS score over 4, a FIM score over 2, or an ISAR score over 3. The outcome variables were revisits to an ED, hospitalization, functional decline, death, and a composite variable of finding any of the previously named variables within 30 days of discharge.
A total of 619 patients were studied. The mean (SD) age was 84 (7) years, and 59.1% were women. The CFS identified as frail a total of 339 patients (54.8%), the FIM 386 (62.4%), and the ISAR 301 (48.6%). An adverse outcome occurred within 30 days in 226 patients (36.5%): 21.5% revisited, 12.6% were hospitalized, 18.4% experienced functional decline, and 3.6% died. The areas under the receiver operating characteristic curves were as follows: CFS, 0.66 (95% CI, 0.62-0.70; P = .022); FIM, 0.67 (95% CI, 0.62-0.71; P = .021), and ISAR, 0.64 (95% CI, 0.60-0.69; P = .023). Adjusted odds ratios (aOR) showed that frailty was an independent risk factor for presenting any of the named adverse outcomes: aOR for CFS >4, 3.18 (95% CI, 2.02-5.01), P .001; aOR for FIM > 2, 3.49 (95% CI, 2.15-5.66), P .001; and aOR for ISAR >3, 2.46 (95% CI, 1.60-3.79), P .001.
All 3 scales studied - the CFS, the FIM and the ISAR - are useful for identifying frail older patients at high risk of developing an adverse outcome (death, functional decline, hospitalization, or revisiting the ED) within 30 days after discharge.
•Several cardiovascular/hemostatic disturbances haves been reported in patients with COVID-19, but the real frequency and their potential association with the pathogenic mechanisms of SARS-CoV-19 ...still remain to be defined.•We investigated the relative frequency of acute coronary syndrome, deep venous thrombosis, pulmonary embolism, stroke and upper gastrointestinal bleeding in COVID patents attending emergency departments (EDs), before hospitalization and compared them with frequencies in the general ED population attending 50 Spanish EDs.•We found that the risk of pulmonary embolism is clearly increased in COVID patients, with an OR of 4.53 with respect to non-COVID patients (95% confidence interval 4.03- 5.10). Additionally, the diagnosis of pulmonary embolism was 2 fold more frequent among ED comers in 2020 compared to 2019, suggesting a SARS-CoV-2 role in such increment of cases.. The remaining entities studied were not found to be unequivocally increased in the present study and need further investigation.
To analyze the impact of the COVID-19 pandemic on Spanish emergency department (ED) care for patients aged 65 years or older during the first wave vs. a pre-pandemic period.
Retrospective ...cross-sectional study of a COVID-19 portion of the EDEN project (Emergency Department and Elder Needs). The EDEN-COVID cohort included all patients aged 65 years or more who were treated in 52 EDs on 7 consecutive days early in the pandemic. We analyzed care variables, discharge diagnoses, use of diagnostic and therapeutic resources, use of observation units, need for hospitalization, rehospitalization, and mortality. These data were compared with data for an EDEN cohort in the same age group recruited during a similar period the year before the pandemic.
The 52 participating hospital EDs attended 33 711 emergencies during the pandemic vs. 96 173 emergencies in the pre-COVID period, representing a 61.7% reduction during the pandemic. Patients aged 65 years or older accounted for 28.8% of the caseload during the COVID-19 period and 26.4% of the earlier cohort (P .001). The COVID-19 caseload included more men (51.0%). Comorbidity and polypharmacy were more prevalent in the pandemic cohort than in the earlier one (comorbidity, 92.6% vs. 91.6%; polypharmacy, 65.2% vs. 63.6%). More esturesources (analgesics, antibiotics, heparins, bronchodilators, and corticosteroids) were applied in the pandemic period, and common diagnoses were made less often. Observation wards were used more often (for 37.8% vs. 26.2% in the earlier period), and hospital admissions were more frequent (in 56.0% vs. 25.3% before the pandemic). Mortality was higher during the pandemic than in the earlier cohort either in ED (1.8% vs 0.5%) and during hospitalization (11.5 vs 2.9%).
The proportion of patients aged 65 years or older decreased in the participating Spanish EDs. However, more resources were required and the pattern of diagnoses changed. Observation ward stays were longer, and admissions and mortality increased over the numbers seen in the reference period.
Recent reports of patients with coronavirus disease 2019 (COVID-19) developing pneumothorax correspond mainly to case reports describing mechanically ventilated patients. The real incidence, clinical ...characteristics, and outcome of spontaneous pneumothorax (SP) as a form of COVID-19 presentation remain to be defined.
Do the incidence, risk factors, clinical characteristics, and outcomes of SP in patients with COVID-19 attending EDs differ compared with COVID-19 patients without SP and non-COVID-19 patients with SP?
This case-control study retrospectively reviewed all patients with COVID-19 diagnosed with SP (case group) in 61 Spanish EDs (20% of Spanish EDs) and compared them with two control groups: COVID-19 patients without SP and non-COVID-19 patients with SP. The relative frequencies of SP were estimated in COVID-19 and non-COVID-19 patients in the ED, and annual standardized incidences were estimated for both populations. Comparisons between case subjects and control subjects included 52 clinical, analytical, and radiologic characteristics and four outcomes.
We identified 40 occurrences of SP in 71,904 patients with COVID-19 attending EDs (0.56‰; 95% CI, 0.40‰-0.76‰). This relative frequency was higher than that among non-COVID-19 patients (387 of 1,358,134, 0.28‰; 95% CI, 0.26‰-0.32‰; OR, 1.93; 95% CI, 1.41-2.71). The standardized incidence of SP was also higher in patients with COVID-19 (34.2 vs 8.2/100,000/year; OR, 4.19; 95% CI, 3.64-4.81). Compared with COVID-19 patients without SP, COVID-19 patients developing SP more frequently had dyspnea and chest pain, low pulse oximetry readings, tachypnea, and increased leukocyte count. Compared with non-COVID-19 patients with SP, case subjects differed in 19 clinical variables, the most prominent being a higher frequency of dysgeusia/anosmia, headache, diarrhea, fever, and lymphopenia (all with OR > 10). All the outcomes measured, including in-hospital death, were worse in case subjects than in both control groups.
SP as a form of COVID-19 presentation at the ED is unusual (< 1‰ cases) but is more frequent than in the non-COVID-19 population and could be associated with worse outcomes than SP in non-COVID-19 patients and COVID-19 patients without SP.
The aim was to develop a predictive model of infection by multidrug-resistant microorganisms (MDRO). A national, retrospective cohort study was carried out including all patients attended for an ...infectious disease in 54 Spanish Emergency Departments (ED), in whom a microbiological isolation was available from a culture obtained during their attention in the ED. A MDRO infection prediction model was created in a derivation cohort using backward logistic regression. Those variables significant at
p
< 0.05 assigned an integer score proportional to the regression coefficient. The model was then internally validated by k-fold cross-validation and in the validation cohort. A total of 5460 patients were included; 1345 (24.6%) were considered to have a MDRO infection. Twelve independent risk factors were identified in the derivation cohort and were combined into an overall score, the ATM (assessment of threat for MDRO) score. The model achieved an area under the curve-receiver operating curve of 0.76 (CI 95% 0.74–0.78) in the derivation cohort and 0.72 (CI 95% 0.70–0.75) in the validation cohort (
p
= 0.0584). Patients were then split into 6 risk categories and had the following rates of risk: 7% (0–2 points), 16% (3–5 points), 24% (6–9 points), 33% (10–14 points), 47% (15–21 points), and 71% (> 21 points). Findings were similar in the validation cohort. Several patient-specific factors were independently associated with MDRO infection risk. When integrated into a clinical prediction rule, higher risk scores and risk classes were related to an increased risk for MDRO infection. This clinical prediction rule could be used by providers to identify patients at high risk and help to guide antibiotic strategy decisions, while accounting for clinical judgment.
Highlights * Several cardiovascular/hemostatic disturbances haves been reported in patients with COVID-19, but the real frequency and their potential association with the pathogenic mechanisms of ...SARS-CoV-19 still remain to be defined. * We investigated the relative frequency of acute coronary syndrome, deep venous thrombosis, pulmonary embolism, stroke and upper gastrointestinal bleeding in COVID patents attending emergency departments (EDs), before hospitalization and compared them with frequencies in the general ED population attending 50 Spanish EDs. * We found that the risk of pulmonary embolism is clearly increased in COVID patients, with an OR of 4.53 with respect to non-COVID patients (95% confidence interval 4.03- 5.10). Additionally, the diagnosis of pulmonary embolism was 2 fold more frequent among ED comers in 2020 compared to 2019, suggesting a SARS-CoV-2 role in such increment of cases.. The remaining entities studied were not found to be unequivocally increased in the present study and need further investigation. Author Affiliation: (a) Hospital Clinic, Barcelona, Spain (b) Hospital Clinico San Carlos, Madrid, Spain (c) Hospital General de Alicante, Spain (d) Hospital Universitario de Canarias, Tenerife, Spain (e) Hospital Universitario Severo Ochoa de Leganes, Madrid, Spain (f) Hospital General Universitario Reina Sofia, Murcia, Spain (g) Complejo Asistencial de Soria, Spain (h) Hospital Universitario Rey Juan Carlos, Madrid, Spain (i) Hospital San Pedro, Logrono, Spain (j) Hospital de Leon, Spain (k) Hospital de la Princesa, Madrid, Spain (l) Hospital Clinico San Carlos, Madrid, Spain (m) Hospital de Fuenlabrada, Madrid, Spain (n) Hospital Clinico Universitario Lozano Blesa, Spain (o) Hospital Clinico Universitario de Salamanca, Spain (p) Complejo Hospitalario Universitario de A Coruna, Spain (q) Hospital Universitario de Bellvitge de l'Hospitalet de Llobregat, Barcelona, Spain (r) Hospital de la Vega Baja de Orihuela, Alicante, Spain (s) Hospital Virgen de los Lirios de Alcoy, Alicante, Spain (t) Hospital Francesc de Borja de Gandia, Valencia, Spain (u) Hospital Doctor Peset, Valencia, Spain (v) Hospital la Fe, Valencia, Spain (w) Hospital Reina Sofia, Murcia, Spain (x) Hospital General de Albacete, Spain (y) Hospital del Vinalopo de Elche, Alicante, Spain (z) Hospital de Torrevieja, Alicante, Spain (aa) Hospital Universitari de Vic, Barcelona, Spain (ab) Hospital General de Alicante, Spain (ac) Hospital Marina Baixa de Villajoyosa, Alicante, Spain (ad) Hospital Arnau de Vilanova, Valencia, Spain (ae) Hospital Clinic de Barcelona, Spain (af) Hospital Universitario LucusAugusti, Lugo, Spain (ag) Hospital de Henares, Madrid, Spain (ah) Hospital Comarcal El Escorial, Madrid, Spain (ai) Hospital Universitario de Burgos, Spain (aj) Hospital Costa del Sol de Marbella, Malaga, Spain (ak) Hospital de Lliria, Valencia, Spain (al) Hospital de Requena, Valencia, Spain (am) Hospital Clinico de Valencia, Spain (an) Hospital Universitario La Ribera, Valencia, Spain (ao) Hospital del Mar, Barcelona, Spain (ap) Hospital Universitario La Paz, Madrid, Spain (aq) Hospital Santa Tecla, Tarragona, Spain (ar) Hospital Rio Hortega, Valladolid, Spain (as) Hospital General de Elche, Alicante, Spain (at) Hospital Universitario Central Asturias, Oviedo, Spain (au) Hospital de Parla, Madrid, Spain (av) Hospital Virgen de la Luz, Cuenca, Spain (aw) Hospital Joan XXIII, Tarragona, Spain (ax) Hospital Universitario de Canarias, Tenerife, Spain (ay) Clinica Universidad Navarra, Madrid, Spain (az) Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (ba) Hospital Juan Ramon Jimenez, Huelva, Spain (bb) Hospital Doctor Josep Trueta, Girona, Spain (bc) Clinica Sagrada Familia, Barcelona, Spain (bd) Hospital Severo Ochoa de Leganes, Madrid, Spain (be) Hospital GermansTrias i Pujol de Badalona, Barcelona, Spain (bf) Hospital Universitario Sant Joan, Alicante, Spain (bg) Hospital Doctor Negrin, Las Palmas de Gran Canaria, Spain (bh) Hospital Nuestra Senora del Prado de Talavera de la Reina, Toledo, Spain (bi) Hospital Valle de los Pedroches de Pozoblanco, Jaen, Spain (bj) Hospital Regional Universitario de Malaga, Spain (bk) Hospital Lluis Alcanyis de Xativa, Valencia, Spain (bl) Hospital Alvaro Cunqueiro de Vigo, Pontevedra, Spain (bm) Consorci Hospitalari de Terrassa, Barcelona, Spain (bn) Hospital de Denia, Alicante, Spain (bo) Hospital de Gijon, Asturias, Spain (bp) Hospital Virgen de la Arrixaca, Murcia, Spain (a) Emergency Department, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain (b) Emergency Department, Hospital General de Alicante, University Miguel Hernandez, Elche, Alicante, Spain (c) Emergency Department, Hospital General UniversitarioReina Sofia, Murcia, Spain (d) Emergency Department, Hospital Universitario de Canarias, Tenerife, Spain (e) Emergency Department, Hospital UniversitarioSevero Ochoa, Universidad Alfonso X, Madrid, Spain (f) Emergency Department, Hospital Clinico San Carlos, IDISSC, Univesdad Complutense, Madrid, Spain * Corresponding author at: Emergency Department, Hospital Clinic, Villarroel 170, 08036 Barcelona, Catalonia, Spain. Article History: Received 27 August 2020; Revised 18 December 2020; Accepted 24 January 2021 Byline: Oscar Miro omiro@clinic.cat (a,*), Pere Llorens (b), Sonia Jimenez (a), Pascual Pinera (c), Guillermo Burillo-Putze (d), Alfonso Martin (e), Francisco Javier Martin-Sanchez (f), Juan Gonzalez del Castillo (f), Oscar Miro (a), Sonia Jimenez (a), Juan Gonzalez del Castillo (b), Francisco Javier Martin-Sanchez (b), Pere Llorens (c), Guillermo Burillo-Putze (d), Alfonso Martin (e), Pascual Pinera Salmeron (f), Fahd Beddar Chaib (g), Enrique del Hoyo Pelaez (g), Belen Rodriguez Miranda (h), Alejandra Sanchez Arias (h), Noemi Ruiz de Lobera (i), Marta Iglesias Vela (j), Laura Hernando Lopez (j), Carmen del Arco Galan (k), Guillermo Fernandez Jimenez (k), E. Jorge Garcia Lamberechts (l), Marcos Fragiel (l), Maria Jesus Dominguez (m), Maria Eugenia Barrero Ramos (m), Jose Maria Ferreras Amez (n), Belen Arribas Entrala (n), Angel Garcia Garcia (o), Marta Fuentes de Frutos (o), Ricardo Calvo Lopez (p), Javier Jacob-Rodriguez (q), Ferran Llopis-Roca (q), Maria Carmen Ponce (r), Napoleon Melendez (s), Maria Jose Fortuny Bayarri (t), Francisco Jose Salvador Suarez (t), Maria Luisa Lopez Grima (u), M*. Angeles Juan Gomez (u), Javier Millan (v), Jose A. Sanchez Nicolas (w), Paula Lazaro Aragues (w), Francisco Javier Lucas-Imbernon (x), Francisco Javier Lucas-Galan (x), Blas Jimenez (y), Blas Jimenez (z), Rigoberto del Rio (z), Lluis LLauger Garcia (aa), Begona Espinosa (ab), Ana Belen Paya (ab), Juan Miguel Porrino (ac), Maria Rosales Maestre (ac), Maria Jose Cano Cano (ad), Rosa Sorando Serra (ad), Carlos Cardozo (ae), Juan Jose Lopez Diaz (af), Martin Ruiz Grinspan (ag), Cristobal M. Rodriguez Leal (ag), Sara Gayoso Martin (ah), Silvia Ortiz Zamorano (ah), Maria Pilar Lopez Diaz (ai), Carmen Aguera Urbano (aj), Elisa Delgado Padial (aj), Ana Peiro Gomez (ak), Elena Gonzalo Bellver (ak), Laura Ejarque Martinez (al), Maribel Marzo Lambies (al), Jose Noceda (am), Jose Vicente Braso Aznar (an), Jose Luis Ruiz Lopez (an), Alfons Aguirre Tejedo (ao), Isabel Cirera Lorenzo (ao), Alejandro Martin Quiros (ap), Elena Munoz del Val (ap), Enrique Martin Mojarro (aq), Brigitte Silvana Alarcon Jimenez (aq), Virginia Carbajosa (ar), Susana Sanchez Ramon (ar), Matilde Gonzalez Tejera (as), Pablo Herrero Puente (at), Desire Maria Velarde Herrera (at), Francisco Javier Teigell Munoz (au), Juan Carlos Reparaz Gonzalez (au), Felix Gonzalez Martinez (av), Diana Moya Olmeda (av), Anna Palau (aw), Patricia Eiroa Hernandez (ax), Marcos Exposito Rodriguez (ax), Nieves Lopez Laguna (ay), Maria Garcia-Uria (ay), Josep Guardiola (az), Polo Higa Sansome (az), Maria Jose Marchena Gonzalez (ba), EissaJaloud Saavedra (ba), Maria Adroher (bb), Ester Soy Ferrer (bb), Arturo Huertas (bc), Raquel Torres Garate (bd), Beatriz Valle Borrego (bd), Josep Maria ModolDeltell (be), Samuel Olmos Soto (be), Elena Diaz Fernandez (bf), Jose Pavon Monzo (bg), Nayra Cabrera Gonzalez (bg), Ricardo Juarez (bh), Jorge Pedraza Garcia (bi), Manuel Salido (bi), Miguel Moreno Fernandez (bj), Carles Perez (bk), Maria Teresa Maza Vera (bl), Raquel Rodriguez Calveiro (bl), Josep Tost (bm), Antonio Barcelo (bn), Rosario Carrio (bo), Eva Quero Moto (bp)
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