Prognosis in COVID-19: Impact of Pre-hospital Emergency Care

Résumé

Background:

Since the beginning of COVID-19 disease, each country has planned a consensus for patient management according to its health system. In Tunisia, Pre-hospital emergency care (PEC) worked in regulating and transporting COVID-19 patients. In the other hand, some patients have chosen to consult the Emergency Department (ED) themselves. Does the way to get to medical care have an impact on the prognosis?                                                                                                            

  Methods:

It was a retrospective descriptive study carried out in the Intensive Care Unit (ICU) of Abderrahmane Mami’s hospital during nine months (from March to November 2020). Patients included were those how were hospitalized for SARS-COV2 infection by PEC (Group1 (G1)) and those admitted via the hospital’s ED (Group2 (G2)). The primary endpoint was mortality.

  Results:

We included 60 patients: 30 for each group. The average age was 62 years for G1 and 63 years for G2 (p=0.18) with a male predominance in both groups (p=0.4). The most common histories were hypertension (14 cases in G1 and G2, p=1), diabetes (10 cases in G1 and 8 cases in G2, p=0.75) and obesity (14 cases in G1 and 12 cases in G2, p=0.55). Patients in G2 consulted the emergency department later with a mean time from symptom onset to hospitalization of 9.6 days (vs. 6.5 days for G1, p=0.02). On admission, they were more asthenic (p=0.024), with a mean spo2 of 89% (vs. 95% in G1, p=0.008). Patients of PEC had less requirement to mechanical ventilation (11 cases vs. 21 in G2, p=0.01). Mortality was significantly higher in G2 patients (21 cases vs. 10 in G1, p=0.04). By multivariate study, the way to get to the ICU (group 1 or 2) was not significantly associated to mortality and only the requirement of mechanical ventilation was (p<0,001; OR = 16,286 and 95% CI [18,406-3801,272]).

Conclusion:

COVID-19 patients admitted to the ICU via PEC had earlier management compared with patients admitted via the ED; they had less serious symptoms with less mortality.