Association of Emergency Department Length of Stay and Hospital Mortality in Patients Under Investigation for COVID-19

Ar-aishah Dadeh, Itsada Chaisuwaseth, Wainik Sookmee Department of Emergency Medicine, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University Hat Yai, Songkhla, 90110, ThailandCorrespondence: Ar-aishah Dadeh, Department of Emergency Medicine, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand, Tel +66 74-451705, Fax +66 74-451704, Email [email protected]: We aimed to determine the association between hospital mortality of patients under investigation (PUI) for COVID-19 and emergency department length of stay (EDLOS).Patients and Methods: A retrospective study was conducted from April 3, 2020 to April 2, 2022. Adult PUI who presented with both clinical and epidemiological risk factors for COVID-19 disease and underwent sample collection with nasal swab for reverse transcription polymerase chain reaction were included in the study. The factors associated with EDLOS and hospital mortality were investigated using univariate logistic regression and multivariate logistic regression analyses.Results: A total of 961 PUI were enrolled that included 836 (87%) non-COVID-19 patients. The median (interquartile range [IQR]) EDLOS durations for 7-day and 30-day mortality of all PUI were 3.1 hours (2.1,4.3, P = 0.231) and 3.2 hours (2.1,4.3, P = 0.653). Multivariate logistic regression analysis revealed that the significant factors associated with EDLOS longer than 4 hours were consultation of three departments (adjusted odds ratio (aOR) 27.3, 95% CI 2.42– 309.71, P = 0.007), emergency severity index (ESI) level 3 (aOR 2.31, 95% CI 1.37– 3.9), investigations > 2 (aOR 2.62, 95% CI 1.62– 4.25), nebulization (aOR 2.34, 95% CI 1.39– 3.96), administration of intravenous fluid (aOR 2.62, 95% CI 1.59– 4.33), performing ≥ 1 procedure (aOR 3.35, 95% CI 1.51– 7.43), and discharged patients (aOR 2.13, 95% CI 1.02– 4.48).Conclusion: The significant factors associated with prolonged EDLOS in PUI included consultation of three departments, ESI level 3, investigations > 2, ED treatment, ED procedures, and discharged patients. The median times of EDLOS and hospital LOS were 3.2 hours and 5.7 days. The EDLOS had no significant association with short-term mortality.Keywords: emergency department length of stay, pandemic, COVID-19, patients under investigation, hospital mortality