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  • Characteristics and outcomes of patients with COVID-19 who return to the emergency department: a multicentre observational study by the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN)

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Original research
Characteristics and outcomes of patients with COVID-19 who return to the emergency department: a multicentre observational study by the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN)
  1. Rhonda J Rosychuk1,
  2. Jaspreet K Khangura2,
  3. Sylvia S Ortiz1,
  4. Ivy Cheng3,4,
  5. Iwona A Bielska5,6,
  6. Justin Yan7,8,
  7. Laurie J Morrison9,10,
  8. Jake Hayward2,
  9. Lars Grant11,12,
  10. Corinne M Hohl13,14
  11. on behalf of the Canadian COVID-19 Rapid Response Network (CCEDRRN) for the Network of Canadian Emergency Researchers (NCER)
  1. 1 Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
  2. 2 Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
  3. 3 Sunnybrook Research Institute, Toronto, Ontario, Canada
  4. 4 Division of Emergency/Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  5. 5 Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
  6. 6 Institute of Public Health, Jagiellonian University, Krakow, Poland
  7. 7 Division of Emergency Medicine, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
  8. 8 Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
  9. 9 Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  10. 10 Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada
  11. 11 Department of Emergency Medicine, McGill University, Montreal, Quebec, Canada
  12. 12 Lady Davis Institute for Medical Research, Montreal, Québec, Canada
  13. 13 Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
  14. 14 Emergency Department, Vancouver General Hospital, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Rhonda J Rosychuk, Department of Pediatrics, University of Alberta, Edmonton, AB T6G 1C9, Canada; rhonda.rosychuk{at}ualberta.ca

Abstract

Objective Unplanned return emergency department (ED) visits can reflect clinical deterioration or unmet need from the original visit. We determined the characteristics and outcomes of patients with COVID-19 who return to the ED for COVID-19-related revisits.

Methods This retrospective observational study used data for all adult patients visiting 47 Canadian EDs with COVID-19 between 1 March 2020 and 31 March 2022. Multivariable logistic regression assessed the characteristics associated with having a no return visit (SV=single visit group) versus at least one return visit (MV=return visit group) after being discharged alive at the first ED visit.

Results 39 809 patients with COVID-19 had 44 862 COVID-19-related ED visits: 35 468 patients (89%) had one visit (SV group) and 4341 (11%) returned to the ED (MV group) within 30 days (mean 2.2, SD=0.5 ED visit). 40% of SV patients and 16% of MV patients were admitted at their first visit, and 41% of MV patients not admitted at their first ED visit were admitted on their second visit. In the MV group, the median time to return was 4 days, 49% returned within 72 hours. In multivariable modelling, a repeat visit was associated with a variety of factors including older age (OR=1.25 per 10 years, 95% CI (1.22 to 1.28)), pregnancy (1.86 (1.46 to 2.36)) and presence of comorbidities (eg, 1.72 (1.40 to 2.10) for cancer, 2.01 (1.52 to 2.66) for obesity, 2.18 (1.42 to 3.36) for organ transplant), current/prior substance use, higher temperature or WHO severe disease (1.41 (1.29 to 1.54)). Return was less likely for females (0.82 (0.77 to 0.88)) and those boosted or fully vaccinated (0.48 (0.34 to 0.70)).

Conclusions Return ED visits by patients with COVID-19 within 30 days were common during the first two pandemic years and were associated with multiple factors, many of which reflect known risk for worse outcomes. Future studies should assess reasons for revisit and opportunities to improve ED care and reduce resource use.

Trial registration number ClinicalTrials.gov, NCT04702945.

  • COVID-19
  • Communicable Diseases
  • viral
  • emergency departments
  • epidemiology

Data availability statement

Data are available upon reasonable request. Data access is governed by the CCEDRRN Protocol Review and Publications Committee and Data Access and Management Committee (contact via amber.cragg@ubc.ca) for researchers who meet the criteria for access to confidential data.

https://doi.org/10.1136/emermed-2023-213277

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    Data availability statement

    Data are available upon reasonable request. Data access is governed by the CCEDRRN Protocol Review and Publications Committee and Data Access and Management Committee (contact via amber.cragg@ubc.ca) for researchers who meet the criteria for access to confidential data.

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    Footnotes

    • Handling editor Kirsty Challen

    • Twitter @RRosychuk

    • Collaborators Canadian COVID-19 Rapid Response Network (CCEDRRN). CCEDRRN members are provided as Supplementary Table 1 in the submission. Network of Canadian Emergency Researchers (NCER) is a corporate author without individuals.

    • Contributors RJR, JKK, IC and CMH conceived the study, with input on the design and selection of variables from all other contributors. CMH, LJM and RJR and obtained funding as principal applicants on behalf of the CCEDRRN investigators. CMH, LJM, JKK, IC, JY, JH and LG managed data collection along with other members of the CCEDRRN and verified the accuracy of underlying data. All contributors developed the analytical plan, and SSO and RJR performed the analysis. All contributors provided input on the interpretation of our findings. RJR, JKK, IB and CMH drafted the manuscript. All authors reviewed and provided critical input to develop the final version. RJR is the guarantor. NCER provided grant review and letter of support.

    • Funding The network is funded by the Canadian Institutes of Health Research (447679, 464947 and 466880), Ontario Ministry of Colleges and Universities (C-655-2129), Saskatchewan Health Research Foundation (5357), Genome BC (COV024 and VAC007), Fondation du CHU de Québec (Octroi No. 4007) and the Public Health Agency of Canada/COVID-19 Immunity Task Force (2122-HQ-000054) who provided peer-reviewed funding. The BC Academic Health Science Network and BioTalent Canada provided non-peer reviewed funding. These organisations are not-for-profit, and had no role in study conduct, analysis or manuscript preparation.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.