key: cord-0946585-y3y1yq36 authors: Boyle, Justin; Sparks, Ross title: Characteristics of patients with COVID‐19 hospitalised in South Australia during the first wave of the pandemic date: 2021-12-13 journal: Emerg Med Australas DOI: 10.1111/1742-6723.13906 sha: 86552b04ac252124930b0295cec252eac46a0dd0 doc_id: 946585 cord_uid: y3y1yq36 OBJECTIVE: To describe the first wave of hospitalisations of patients testing positive for COVID‐19 in South Australia. METHODS: Pathology test results for COVID‐19 between January and June 2020 were matched against state‐wide ED and inpatient data sets. RESULTS: The impact of the first wave of COVID‐19 on South Australian hospitals was 440 unique patients with COVID‐19; median ED, hospital and ICU lengths of stay of 4.7 h, 9.8 days and 4.1 days, respectively; and a crude mortality rate of 0.23 deaths per 100 000 population (four deaths). CONCLUSION: The study sheds light on the characteristics of patients with COVID‐19 hospitalised in South Australia. Many health jurisdictions require quantification of the impact of COVID-19 on hospitals at a state level, particularly the impact on hospital EDs and inpatient wards which need to maintain capacity. 1 In the present study, we describe the first wave of hospitalisations of patients testing positive for COVID-19 in South Australia by assessing clinician-assigned primary diagnoses assigned in the ED and on hospital admission. were matched against state-wide hospitalisation data to provide insight into the impact of the virus on South Australian hospitals and characteristics of hospitalised patients with COVID-19. The data spanned from 1 January 2020 to 12 June 2020, and covered all 14 public metropolitan and major country hospitals for ED episodes, an additional six private and smaller country South Australian sites for inpatient episodes which had no ED presentations and state-wide results related to testing for COVID-19. Data extracts were linked using a unique patient ID. When assessing hospitalisations of patients with COVID-19, we considered all ED presentations and admissions between 1 January 2020 and 12 June 2020 for patients who tested positive for COVID-19. This is a defensible matching period to include patients who may have presented to the ED with a related symptom before being confirmed positive (COVID-19 monitoring in Australia has occurred since 22 January 2020 with the first confirmed case in late January 2020 2 ). An exemption from ethical review for this analysis was granted by the SA Department for Health and Wellbeing Human Research Ethics Committee (ref: REC/20/SAH/35). Up to 12 June 2020, there were 102 424 COVID-19 tests from 93 744 unique patients. The number of positive test results was 830, representing a positive test ratio of 0.81% of tests undertaken. These positive tests were from 440 unique patients, and of these, 86 presented to the ED at a major South Australian public hospital between 1 January and 12 June 2020 and 66 of these were admitted to hospital. There were an additional 53 patients admitted at the major metropolitan hospitals without going through the ED, resulting in 119 admitted patients. Several patients had multiple ED presentations and admissions during this time, such that the 86 ED patients corresponded to 111 relevant ED presentations and the 119 admitted patients corresponded to 206 associated inpatient episodes. Over a third of 111 ED presentations with COVID-19 arrived by ambulance and only 4% were triaged into the least urgent triage category. Median ED length of stay (LOS) for the 111 ED presentations was 4.7 h (interquartile range [IQR] 2.9-6.7 h), with a maximum stay of 18 h. The median inpatient LOS for the 206 inpatient episodes with 'Medical care', and the high prevalence of respiratory illnesses, cough and fever mirrored the World Health Organization's case definitions for coronavirus surveillance. 4 The most prevalent diagnosis for inpatient stays incorporating an ICU admission was J12.8 'Viral pneumonia', while the most prevalent ED diagnosis for patients with COVID-19 was B34.2 'Coronavirus infection, unspecified site' (47% of cases). Figure 1 summarises counts and sex (coloured bars drawn to scale), age (box-whisker plots) and prevalent diagnoses for patients with COVID-19 in South Australia. We observe that the admitted patient cohort is larger than the cohort of ED presentations (patients were admitted without going through the ED); there are slightly more males in each cohort; and age generally increases with care needs except for the admitted patient cohort. The present study sheds light on characteristics of patients with COVID-19 hospitalised in South Australia. There is new knowledge regarding primary diagnoses assigned in hospital for patients who tested positive for COVID-19. The most prevalent diagnosis (47%) in ED for patients with COVID-19 was 'Coronavirus infection, unspecified site', a code that does not appear in the study data set before February 2020. Initial advice 5 by the US Centers for Disease Control and Prevention (CDC) for coronavirus coding stated that this diagnosis code was generally not appropriate for COVID-19, because the cases had until then been respiratory in nature, so the site of any infection on a patient would not be 'unspecified'. However, it is noted that patients with COVID-19 have been reported to present with nonrespiratory symptoms 6,7 such as muscle aches and pains (myalgia) and loss of sense of smell (anosmia) as seen in our study. Ocular symptoms of COVID-19 have also been reported where the ocular surface was suggested as a portal to the respiratory system. 8 In our study, the earliest presentation with ED notes occurred on 14 January 2020, and related to an eye complaint (nursing assessment: 'bilat eye pain. Both eyes look red'). Updated International Classification of Disease (ICD) coding guidelines 9 make reference to a new diagnosis code established by the World Health Organization for COVID-19 ('U07.1'), which is likely to be implemented in the next ICD update. 10 Use of this code is growing and its inclusion in syndromic surveillance and future epidemiological studies is acknowledged. 11 Further advice regarding the classification of COVID-19 cases in Australian hospitals has been issued by the Independent Hospital Pricing Authority. 12 When matching pathology tests to hospital visits, we adopted a criterion of matching all ED presentations and inpatient admissions between January and June 2020 from patients who tested positive for COVID-19. It is possible that some hospitalisations are unrelated to the virus. Linking state-wide ED, inpatient and pathology data can quantify hospital impacts and support health jurisdictions in their preparedness and planning in response to the novel coronavirus. The authors have commenced the next step in response planning by developing syndromic surveillance models that detect outbreaks to assist further with response preparedness and day-to-day hospital capacity management and operations. 13 Australian Bureau of Statistics. 31010do001_202006 National, state and territory population WHO COVID-19: Case Definitions, Updated in Public Health Surveillance for COVID-19 Centers for Disease Control and Prevention. ICD-10-CM Official Coding Guidelines -Supplement. 2020 Smell and taste dysfunction in patients with SARS-CoV-2 infection: a review of epidemiology, pathogenesis, prognosis, and treatment options. Asian Pac Smell loss is a prognostic factor for lower severity of COVID-19 Evaluation of ocular symptoms and tropism of SARS-CoV-2 in patients confirmed with COVID-19 Centers for Disease Control and Prevention. New ICD-10-CM code for the 2019 Novel Coronavirus (COVID-19) Special report: early use of ICD-10-CM code "U07.1, COVID-19" to identify 2019 novel coronavirus cases in Military Health System administrative data Independent Hospital Pricing Authority. How to classify COVID-19 Syndromic surveillance to detect disease outbreaks using time between emergency department presentations We acknowledge the support of this work from CSIRO and SA Health's Commission for Excellence and Innovation in Health and thank the members of its data team and SA Pathology for facilitating extracts of data used in the present study. None declared. Data analysed in this study is unable to be shared due to legislative and review committee requirements. The original data are available from SA Health and SA Pathology subject to appropriate governance and ethical approvals.