Comparison of the clinical process and outcomes in patients with fever
who visited the emergency department before and after coronavirus
infection 2019 outbreak
Abstract
Rationale, aims and objectives: The coronavirus infection 2019
(COVID-19) pandemic has affected the emergency department (ED)
management. Its viral transmission necessitates the use of isolation
rooms and personal protective equipment for treating suspected patients,
such as those with fever. This delays the time until the first encounter
with the patients, thereby increasing the length of stay (LOS) in the
ED. We aimed to compare delays in the ED LOS and clinical processes
between the COVID-19 period and pre-COVID-19 period. Moreover, we
intended to evaluate if the aforementioned delay affected patient
outcomes. Methods: We conducted a single-center, retrospective study in
Korea. Patients with fever were compared between the “COVID-19 period”
from March 2020 to August 2020 and the “pre-COVID-19 period” from
March 2019 to September 2019. We compared the overall ED LOS and
individual time variable, including initial diagnostic tests (laboratory
tests, radiography), specific diagnostic test (computed tomography), and
treatment processes (antibiotics). A logistic regression analysis was
conducted to identify the association between hospital admission and
patient data. Results: We enrolled 931 and 749 patients during pre- and
COVID-19 periods, respectively. Patients with fever remained in the ED
for a longer duration during the COVID-19 period
(pre-COVID-19:207.7±102.7 min vs. during COVID-19: 223.5±119.4 min,
p=0.004). The total time for performing laboratory tests and radiography
displayed significant differences between the two periods, particularly
from the time of patient arrival in the ED to the time of issuing the
order. The time until antibiotic administration was delayed in the
COVID-19 period (pre-COVID-19:195.8±103.3 min vs. during COVID-19:
216.9±108.4 min, p=0.003). The logistic regression analysis for hospital
admission identified ED LOS as an independent factor in both periods.
Conclusion: The delay until encountering patients with fever resulted in
longer ED LOS during the COVID-19 period; however, it possibly did not
increase the hospital admission rates.