Management of patients with suspected COVID-19 in European EDs; an EUSEM Research Network study

Best practice in the management of COVID-19 patients is still changing, and the management of infected patients in the emergency department (ED) presents distinct problems as compared to other specialties. Now, emergency medicine researchers from across Europe have found that patients who were admitted to the ED and had a confirmed COVID-19 infection were in a more critical clinical situation than those who had a suspected COVID-19 infection that was not confirmed subsequently. The study1, the first on this scale in Europe to examine this issue from the emergency physicians’ point of view, was carried out by members of the EUSEM Research Network2 and published in the Journal of Personalized Medicine.

The researchers studied a total of 7432 patients from seven European countries, 1764 (23%) of whom had a confirmed infection (the C+ group), and 5688 (76.3%) who did not (the C- group). Patients in the C+ group had more chronic disease, more of them were male, and they were also older than the C- patients.  Two-thirds of the C+ patients were transferred to a hospital ward, whereas two-thirds of patients in the C- group were discharged after their visit to the ED.

“Because of the continuing uncertainty about the best way to handle COVID-19 patients, particularly in the ED, we thought it was important to investigate the differences in outcomes between the two groups in order that emergency medicine professionals can rely on solid data related to possible clinical outcomes,” said Professor Said Laribi, from the EM Department at Tours University Hospital, Tours, France.  “In a field where we are all still learning about best practice, these data are particularly valuable. For example, at the beginning of the pandemic, most suspected COVID cases were hospitalised, whereas now this only happens to those with a severe case of infection.”

Results from the study showed that, among the 4338 patients discharged from the emergency department without hospitalisation, 396 returned to the ED after the initial assessment. The proportion of readmissions was twice as high in the C+ group as in the C- group.

“Currently, following their evaluation in the ED, many COVID-19 infected patients are discharged to ambulatory care. However, our study shows that a significant number of them may deteriorate and require hospitalisation. We hope, therefore, that identifying such patients will be useful in EDs. We would like to see further research in emergency medicine at a European level. This could not only improve our knowledge from the ED perspective, but also lead to evidence-based standardisation in patient care,” Prof Laribi concluded.

1.Chauvin et al J. Pers. Med. 2022, 12, 2085.