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- W3207363617 abstract "TOPIC: Practice Management and Administration TYPE: Original Investigations PURPOSE: Low-risk patients who have mild to moderate Coronavirus Disease 2019 (COVID-19) can be safely managed at home either through helplines or a structured Telehealth program. However, high-risk patients with same mild to moderate disease present a challenging problem as they can rapidly deteriorate and have up to 12 times higher mortality rate. If these symptomatic high-risk patients worsen to the point that they present to the Emergency Department (ED), some physicians tend to admit them even if they do not fulfill the admission criteria. Whether these patients can be safely discharged home under surveillance of Telehealth needs to be explored. We conducted this study to evaluate this issue. METHODS: CDC has identified certain risk-factors for disease progression and worse outcome in COVID-19. Patients with 3 or more of these risk factors were designated as 'high-risk' in our study. Such patients with mild to moderate disease were admitted to our hospital before October 2020. However, later these patients were discharged home under Telehealth service. We evaluated all such patients, between August and mid December 2020, who presented to the ED with disease severity not otherwise fulfilling the admission criteria. Measured outcomes included 28-mortality, rate of ICU admission, and number of inpatient days. Continuous variables were described as median with Interquartile Range between Q1-Q3 (IQR), and categorical variables were described as such. Fisher's exact test, Mann-Whitney or t-test were used to compare the two groups, as appropriate. RESULTS: During the study period 95 patients met the inclusion criteria. Out of these, 31 were admitted to the hospital in August and September of 2020. 63 patients were discharged home from ED under Telehealth service from October till December of 2020. Mean age was 51 years and patients were overweight with a BMI of around 29 kg/m2. Among those admitted to the hospital, median hospital stay was 5 days (IQR 3-6.5 days). 3 of these patients required high-flow oxygen and ICU admission. In the Telehealth group, 19 patients were brought back to ED for re-evaluation and 14 of these ended up getting admitted to the hospital. 2 of these required ICU admissions and one was intubated. None of the patients died in the study and there was no difference in terms of requirement for oxygen, intubation, and ICU admission (p>.74). Telehealth saved a median of 4 hospital days per patient (p<.001). CONCLUSIONS: Symptomatic high-risk COVID-19 patients, with mild to moderate disease, who present to the hospital but do not meet admission criteria have an alternative in the form of Telehealth. It appears to be safe and cost effective. This needs further evaluation in large randomized trials so the Telehealth scope could be expanded in future epidemics or pandemics. CLINICAL IMPLICATIONS: Scope of Telemedicine can be expanded to include high-risk populations in a pandemic like COVID-19. DISCLOSURES: No relevant relationships by Afnan Afifi, source=Web Response No relevant relationships by Muhammad Ali Akhtar, source=Web Response No relevant relationships by Abdullah Alraddadi, source=Web Response No relevant relationships by Elaf Alzarnougi, source=Web Response No relevant relationships by Khadija Amanullah, source=Web Response No relevant relationships by Maryam Imran, source=Web Response No relevant relationships by Manahil Imran, source=Web Response No relevant relationships by Imran Khalid, source=Web Response No relevant relationships by Tabindeh Khalid, source=Web Response No relevant relationships by Saifullah Khan, source=Web Response No relevant relationships by Mohammad Saeedi, source=Web Response" @default.
- W3207363617 created "2021-10-25" @default.
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- W3207363617 date "2021-10-01" @default.
- W3207363617 modified "2023-09-24" @default.
- W3207363617 title "TO ADMIT OR DISCHARGE? OUTCOME OF HIGH-RISK PATIENTS WITH COVID-19 PRESENTING WITH MODERATE DISEASE TO THE HOSPITAL" @default.
- W3207363617 doi "https://doi.org/10.1016/j.chest.2021.07.1739" @default.
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