An integrated emergency department/hospital at home model in mild COVID-19 pneumonia: feasibility and outcomes after discharge from the emergency department.

To evaluate the effectiveness of an integrated emergency department (ED)/hospital at home (HH) medical care model in mild COVID-19 pneumonia and evaluate baseline predictors of major outcomes and potential savings. Retrospective cohort study with patients evaluated for COVID-19 pneumonia in the ED, from March 3 to April 30, 2020. All of them were discharged home and controlled by HH. The main outcomes were ED revisit and the need for deferred hospital admission (protocol failure). Outcome predictors were analyzed by simple logistic regression model (OR; 95% CI). Potential savings of this medical care model were estimated. Of the 377 patients attended in the ED, 109 were identified as having mild pneumonia and were included in the ED/HH medical care model. Median age was 50.0 years, 52.3% were males and 57.8% had Charlson index ≥ 1. The median HH stay was 8 (IQR 3.7-11) days. COVID-19-related ED revisit was 19.2% (n = 21) within 6 days (IQR 3-12.5) after discharge from ED. Overall protocol failure (deferred hospital admission) was 6.4% (n = 7), without ICU admission. The ED/HH model provided potential cost savings of 77% compared to traditional stay, due to the costs of home care entails 23% of the expenses generated by a conventional hospital stay. 789 days of hospital stay were avoided by HH, rather than hospital admission. An innovative ED/HH model for selected patients with mild COVID-19 pneumonia is feasible, safe and effective. Less than 6.5% of patients requiring deferred hospital admission and potential savings were generated due to hospitalization.

Características clínicas, factores de riesgo y resultados finales de pacientes con COVID-19 diagnosticados de tromboembolia de pulmón en urgencias / Clinical findings, risk factors, and final outcome in patients diagnosed with pulmonary thromboembolism and COVID-19 in hospital emergency departments

OBJETIVO: Analizar las características clínicas, analíticas, radiológicas y los resultados finales de salud en una cohorte de pacientes con embolia pulmonar (EP) y COVID-19, y compararlas con un grupo de pacientes con EP sin COVID-19. MÉTODO: Estudio multicéntrico, observacional y retrospectivo realizado en cuatro servicios de urgencias hospitalarios (SUH) españoles del 15 de enero al 15 de abril de 2020. La detección de EP se hizo mediante la revisión de todas las angiografías por tomografía computarizada (angioTC) pulmonares solicitadas desde los SUH. Se han analizado dos grupos de pacientes con EP, con o sin enfermedad por COVID-19, y se comparan las características clínicas, analíticas, radiológicas, antecedentes y comorbilidad, factores de riesgo y resultados finales. RESULTADOS: Se realizaron 399 angioTC y se diagnosticaron 88 EP, 28 (32%) en pacientes con COVID-19. Estos pacientes fueron con más frecuencia hombres y tenían más antecedentes de enfermedad tromboembólica previa. No hubo diferencias en la presentación clínica, características analíticas o radiológicas ni en los resultados finales entre ambos grupos. La mortalidad intrahospitalaria fue del 7% (2 casos) en pacientes COVID y del 17% (10 casos) en pacientes sin COVID (OR de muerte en pacientes COVID con EP: 0,38, IC 95%: 0,08-1,89). CONCLUSIONES: No se han observado diferencias clínicamente relevantes en las características clínicas, analíticas, radiológicas y los resultados finales de salud en una cohorte de pacientes con EP y COVID-19 respecto a los pacientes con EP sin esta enfermedad atendidos en los SUH

OBJECTIVE: To analyze clinical, laboratory, and radiologic findings and final health outcomes in patients with pulmonary embolism and coronavirus disease 2019 (COVID-19). To compare them to findings and outcomes in patients with pulmonary embolism without COVID-19. METHODS: Multicenter, observational, retrospective study in 4 Spanish hospital emergency departments (EDs) from January 15 to April 15, 2020. Cases were located by reviewing all ED requests for pulmonary computed tomography angiography (CTA) procedures. Clinical, laboratory, and radiologic findings; medical histories and comorbidity; risk factors; and outcomes were compared between the 2 groups of patients (with or without COVID-19). RESULTS: A total of 399 CTAs were ordered; 88 pulmonary embolisms were diagnosed, 28 of them (32%) in patients with COVID-19. This group had more men, and a history of thromboembolic disease was more common. We found no between-group differences in clinical presentation, laboratory, or radiologic findings; nor were there differences in final outcomes. In-hospital mortality was 7% (2 cases) in patients with COVID-19 and 17% (10 cases) in patients without the virus (odds ratio for death in patients with pulmonary embolism and COVID-19, 0.38; 95% CI, 0.08-1.89). CONCLUSIONS: We found no clinically important differences in the clinical, laboratory, or radiologic findings between patients with or without COVID-19 who were treated for pulmonary embolism in our hospital EDs. Final outcomes also did not differ

Clinical findings, risk factors, and final outcome in patients diagnosed with pulmonary thromboembolism and COVID-19 in hospital emergency departments. / Características clínicas, factores de riesgo y resultados finales de pacientes con COVID-19 diagnosticados de tromboembolia de pulmón en urgencias.

OBJECTIVES: To analyze clinical, laboratory, and radiologic findings and final health outcomes in patients with pulmonary embolism and coronavirus disease 2019 (COVID-19). To compare them to findings and outcomes in patients with pulmonary embolism without COVID-19. MATERIAL AND METHODS: Multicenter, observational, retrospective study in 4 Spanish hospital emergency departments (EDs) from January 15 to April 15, 2020. Cases were located by reviewing all ED requests for pulmonary computed tomography angiography (CTA) procedures. Clinical, laboratory, and radiologic findings; medical histories and comorbidity; risk factors; and outcomes were compared between the 2 groups of patients (with or without COVID-19). RESULTS: A total of 399 CTAs were ordered; 88 pulmonary embolisms were diagnosed, 28 of them (32%) in patients with COVID-19. This group had more men, and a history of thromboembolic disease was more common. We found no between-group differences in clinical presentation, laboratory, or radiologic findings; nor were there differences in final outcomes. In-hospital mortality was 7% (2 cases) in patients with COVID-19 and 17% (10 cases) in patients without the virus (odds ratio for death in patients with pulmonary embolism and COVID-19, 0.38; 95% CI, 0.08-1.89). CONCLUSION: We found no clinically important differences in the clinical, laboratory, or radiologic findings between patients with or without COVID-19 who were treated for pulmonary embolism in our hospital EDs. Final outcomes also did not differ.

OBJETIVO: Analizar las características clínicas, analíticas, radiológicas y los resultados finales de salud en una cohorte de pacientes con embolia pulmonar (EP) y COVID-19, y compararlas con un grupo de pacientes con EP sin COVID-19. METODO: Estudio multicéntrico, observacional y retrospectivo realizado en cuatro servicios de urgencias hospitalarios (SUH) españoles del 15 de enero al 15 de abril de 2020. La detección de EP se hizo mediante la revisión de todas las angiografías por tomografía computarizada (angioTC) pulmonares solicitadas desde los SUH. Se han analizado dos grupos de pacientes con EP, con o sin enfermedad por COVID-19, y se comparan las características clínicas, analíticas, radiológicas, antecedentes y comorbilidad, factores de riesgo y resultados finales. RESULTADOS: Se realizaron 399 angioTC y se diagnosticaron 88 EP, 28 (32%) en pacientes con COVID-19. Estos pacientes fueron con más frecuencia hombres y tenían más antecedentes de enfermedad tromboembólica previa. No hubo diferencias en la presentación clínica, características analíticas o radiológicas ni en los resultados finales entre ambos grupos. La mortalidad intrahospitalaria fue del 7% (2 casos) en pacientes COVID y del 17% (10 casos) en pacientes sin COVID (OR de muerte en pacientes COVID con EP: 0,38, IC 95%: 0,08-1,89). CONCLUSIONES: No se han observado diferencias clínicamente relevantes en las características clínicas, analíticas, radiológicas y los resultados finales de salud en una cohorte de pacientes con EP y COVID-19 respecto a los pacientes con EP sin esta enfermedad atendidos en los SUH.

Oxigenoterapia y cuidados paliativos en pacientes con insuficiencia cardiaca / Oxygen therapy and palliative care in patients with heart failure

No disponible