Diagnostic groups and short-term outcomes in suspected COVID-19 cases treated in an emergency department/ Categorias diagnosticas y resultados a corto plazo en los pacientes con sospecha de COVID-19 atendidos en un servicio de urgencias

OBJECTIVES: The primary objective was to describe the clinical characteristics and 30-day mortality rates in emergency department patients with coronavirus disease 2019 (COVID-19) in different diagnostic groupings MATERIAL AND METHODS: Secondary analysis of the COVID-19 registry compiled by the emergency department of Hospital Clinico San Carlos in Madrid, Spain We selected suspected COVID-19 cases treated in the emergency department between February 28 and March 31, 2020 The cases were grouped as follows: 1) suspected, no polymerase chain reaction (PCR) test (S/no-PCR);2) suspected, negative PCR (S/PCR-);3) suspected, positive PCR (S/PCR+);4) highly suspected, no PCR, or negative PCR (HS/no or PCR-);and 5) highly suspected, positive PCR (HS/PCR+) We collected clinical, radiologic, and microbiologic data related to the emergency visit The main outcome was 30-day all-cause mortality Secondary outcomes were hospitalization and clinical severity of the episode RESULTS: A total of 1993 cases (90 9%) were included as follows: S/no-PCR, 17 2%;S/PCR-, 11 4%;S/PCR+, 22 1%;HS/no PCR or PCR-, 11 7%;and HS/PCR+, 37 6% Short-term outcomes differed significantly in the different groups according to demographic characteristics;comorbidity and clinical, radiographic, analytical, and therapeutic variables Thirty-day mortality was 11 5% (56 5% in hospitalized cases and 19 6% in cases classified as severe) The 2 HS categories and the S/PCR+ category had a greater adjusted risk for 30-day mortality and for having a clinically severe episode during hospitalization in comparison with S/PCR- cases Only the 2 HS categories showed greater risk for hospitalization than the S/PCR- cases CONCLUSION: COVID-19 diagnostic groups differ according to clinical and laboratory characteristics, and the differences are associated with the 30-day prognosis OBJETIVO: El objetivo principal fue describir el perfil clinico y la mortalidad a los 30 dias de diferentes categorias diagnosticas en los casos de COVID-19 atendidos en un servicio de urgencias (SU) METODO: Analisis secundario del registro COVID-19_URG-HCSC Se seleccionaron los casos sospechosos de COVID-19 atendidos en un SU de Madrid desde el 28 de febrero hasta el 31 de marzo de 2020 La muestra se dividio: 1) sospecha con PCR no realizada (S/PCR NR);2) sospecha con PCR negativa (S/PCR-);3) sospecha con PCR positiva (S/ PCR+);4) alta sospecha con PCR negativa o no realizada (AS/PCR- o NR);y 5) alta sospecha con PCR positiva (AS/ PCR+) Se recogieron variables clinicas, radiologicas y microbiologicas del episodio de urgencias La variable de resultado principal fue la mortalidad por cualquier causa a los 30 dias Las variables secundarias fueron el ingreso y la gravedad del episodio RESULTADOS: Se incluyeron 1 993 pacientes;17,2% S/PCR NR, 11,4% S/PCR-, 22,1% S/PCR+, 11,7% AS/PCR- o NR y 37,6% AS/PCR+ Se hallaron diferencias estadisticamente significativas respecto a las variables demograficas, comorbilidad, clinicas, radiograficas, analiticas y terapeuticas y de resultados a corto plazo en funcion las categorias diagnosticas La mortalidad global a los 30 dias fue de un 11,5%, 56,5% casos fueron hospitalizados y 19,6% casos sufrieron un episodio grave Las categorias de AS y de S/PCR+ tuvieron un incremento del riesgo ajustado de mortalidad a los 30 dias y de sufrir un episodio grave durante el ingreso hospitalario respecto a S/PCR- En relacion al ingreso, solo las categorias de AS tuvieron un incremento del riesgo ajustado de hospitalizacion respecto a la categoria de S/PCR- CONCLUSIONES: Existen diferentes categorias diagnosticas de la enfermedad COVID-19 en funcion del perfil clinico y microbiologico que tienen correlato con el pronostico a 30 dias