Academic Emergency Medicine
Background and Objectives: During the global COVID 19 pandemic, emergency rooms (ER) across the nation turned to drive through evaluations to boost efficiency. Patients were evaluated in their car and those identified as low risk were discharged home. While we can highlight the benefit of this process in limiting crowding, preserving personal protective equipment, and reducing exposure risk, there is scarce evidence regarding the effectiveness of these evaluations in risk stratifying these patients. Methods: This is a retrospective study conducted at a tertiary care center on patients 18 years and older who presented to the ER via the drive through evaluation between March 10 and May 10, 2020. Patients that were not discharged home after evaluation were excluded from the study. Patient demographics, presenting signs and symptoms, and medical history were collected. The primary outcome was defined as readmission to the ER within 7 days. A logistic analysis was conducted to assess if patient characteristics at initial presentation predict the primary outcome. Results: Of 2839 patients that met inclusion criteria, 175 returned to the ER within 7 days. Patients older than 65 years were more likely to return than younger patients (10.5% vs 5.7%, p = 0.001). A history of coronary artery disease (odds ration [OR] 2.01) or hypertension (OR 1.44) were associated with return to ER within 7 days (p = 0.03). A heart rate > 90 bpm (7.8% vs 4.2%, p = 0.001), respiratory rate > 18/min (8.7% vs 5.5%, p = 0.003), temperature >38℃ (16.3% vs 5.7%, p < 0.001), and pulse oximeter < 94% (13% vs 6.1%, p = 0.04) were independently associated with return to ER within 7 days. A multivariable logistic regression model was further build in predicting return to ER within 7 days (c-statistics = 0.73). We found that age older than 65 years (adjusted odds ration [aOR] 2.23), male (aOR 1.5), fever (aOR 2.36), and RR (aOR 1.57) were significantly associated with increased odds of ER admission. Conclusion: Overall, 6.2% of patients discharged from the ER after drive through evaluation returned to the ER within 7 days. Risk factors significantly associated with return to ER, including older age, history of coronary artery disease, and any abnormal vital signs on presentation, were discovered. These findings may be useful in identifying patients who could potentially require further workup on initial visit
Mroue K, Kenaan I, Downing N, Chen N. Effectiveness of drive-through evaluations at identifying low risk patients during a pandemic. Acad Emerg Med. 2021 May;28(Suppl 1):S296.