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ABSTRACT Background: Information is needed on the safety and efficacy of direct discharge from the emergency department (ED) of patients with COVID-19 pneumonia. Objectives: The objectives of the study were to study the variables associated with discharge from the ED in patients presenting with COVID-19 pneumonia, and study ED revisits related to COVID-19 at 30 days (EDR30d). Methods: Multicenter study of the SIESTA cohort including 1198 randomly selected COVID patients in 61 EDs of Spanish medical centers from March 1, 2020, to April 30, 2020. We collected baseline and related characteristics of the acute episode and calculated the adjusted odds ratios (aOR) for ED discharge. In addition, we analyzed the variables related to EDR30d in discharged patients. Results: We analyzed 859 patients presenting with COVID-19 pneumonia, 84 (9.8%) of whom were discharged from the ED. The variables independently associated with discharge were being a woman (aOR 1.890; 95%CI 1.176-3.037), age < 60 years (aOR 2.324; 95%CI 1.353-3.990), and lymphocyte count > 1200/mm3 (aOR 4.667; 95%CI 1.045-20.839). The EDR30d of the ED discharged group was 40.0%, being lower in women (aOR 0.368; 95%CI 0.142-0.953). A total of 130 hospitalized patients died (16.8%) as did two in the group discharged from the ED (2.4%) (OR 0.121; 95%CI 0.029-0.498). Conclusion: Discharge from the ED in patients with COVID-19 pneumonia was infrequent and was associated with few variables of the episode. The EDR30d was high, albeit with a low mortality.
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La infl uenza A/H1N1 se diagnosticó por primera vez en México y Estados Unidos en abril de 2009. La rapidezde su diseminación mundial ha alertado a las autoridades sanitarias y a la comunidad científi ca internacional.Los síntomas clínicos habituales de esta enfermedad pueden no distinguirse de la infl uenza estacionale incluyen: tos, fi ebre, mal estado general, odinofagia y dolores musculares. Hasta el momento latasa de hospitalización es relativamente baja (menos de un 15%). De la población afectada, hay 2 gruposque presentan una mayor morbimortalidad: embarazadas y mayores de 65 años. El tratamiento es con losinhibidores de la neuraminidasa: oseltamivir, zanamivir y peramivir, que ayudarían a disminuir las complicacionesy el tiempo de duración de los síntomas. El diagnóstico defi nitivo se hace basándose en técnicasde rt-PCR. El resto del tratamiento consiste en las medidas universales de aislamiento, antitérmicos y reposo.La tasa de casos fatales (aunque en Latinoamérica parece ser más alta) se reporta globalmente comomenor del 1%. En este estudio se hace una recopilación de la información disponible acerca de las manifestaciones,criterios de diagnóstico y tratamiento/profi laxis de la enfermedad(AU)
Influenza A (H1N1) was fi rst diagnosed in Mexico and the United States in April 2009. The rapidity of itsworldwide spread has alerted the health authorities and international scientifi c community. The usualclinical symptoms of this disease cannot be distinguished from those of seasonal infl uenza and includecough, fever, poor general status, odynophagia and muscular aches. To date, the hospitalization rate hasbeen relatively low (less than 15%). Among the affected population, there are two groups with highmorbidity and mortality: pregnant women and persons aged more than 65 years. Treatment consists of theneuroaminidase inhibitors oseltamivir, zanamivir and peramivir, which can help to reduce complicationsand symptom duration. Defi nitive diagnosis is based on reverse-transcriptase polymerase chain reactiontechniques. The remaining treatment options consist of universal measures of isolation, antipyretics andrest. Mortality is less than 1% globally but seems to be higher in Latin America. The present study gathersthe available information on the manifestations, diagnostic criteria and treatment/prophylaxis of thedisease(AU)