Study characterizes suspected COVID-19 infections in emergency departments in the UK

November 25, 2020

Among patients reporting to hospital emergency departments (EDs) with suspected COVID-19 infection, important differences in symptoms and outcome exist based on age, sex and ethnicity, according to a new study published this week in the open-access journal PLOS ONE by Steve Goodacre of the University of Sheffield, UK, and colleagues.

Hospital EDs have played a crucial role during the COVID-19 pandemic in receiving acutely ill patients, determining their need for hospital admission, and providing treatment. Appropriate management of the heterogeneous population of patients who are suspected of having COVID-19 is an important challenge that needs to be informed by relevant data.

In the new paper, part of the Pandemic Respiratory Infection Emergency System Triage (PRIEST) study and funded by the National Institute for Health Research (NIHR), researchers collected a mixture of prospective and retrospective data from 22,445 people presenting to 70 EDs across the UK with suspected COVID-19 infection between March 26, 2020 and May 28, 2020. Data on sex, age, ethnicity, presenting symptoms, admission to hospital, COVID-19 result, organ support and death was available for each patient 30 days after initial presentation. This study is one of a number of COVID-19 studies that have been given urgent public health research status by the Chief Medical Officer/ Deputy Chief Medical Officer for England.

On average, those included in the study were 58.4 years old, 50.4% female, and 84.75% white. Adults admitted to the hospital with confirmed COVID-19 were more than twice as likely to die or receive organ support than adults who did not have COVID-19, suggesting a worse outcome from COVID-19 than similar presentations. Compared to children aged 16 years and under, adults were sicker, had higher rates of hospital admission (67.1% vs 24.7%), COVID positivity (31.2% vs 1.2%) and death (15.9% vs 0.3%). Men were also more likely to be admitted to the hospital than women (72.9% vs 61.4%), required more organ support (12.2% vs 7.7%) and were more likely to die (18.7% vs 13.3%).

In addition, ethnicity conveyed some differences--Black and Asian adults tended to be younger than White adults and, while they were less likely to be admitted to the hospital (Black 60.8%, Asian 57.3%, White 69.6%), they were more likely to require organ support (15.9%, 14.3%, 8.9%) and, importantly, more likely to have a positive COVID-19 test (40.8%, 42.1%, 30.0%).

The authors add: "Our findings show that people attending emergency departments with suspected COVID-19 were seriously ill, suggesting that policies aimed at diverting less serious cases away from hospitals were successful. We also showed that admission with COVID-19 carries a much higher risk of death or need for life-saving treatment than admission with similar conditions."
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Goodacre S, Thomas B, Lee E, Sutton L, Loban A, Waterhouse S, et al. (2020) Characterisation of 22445 patients attending UK emergency departments with suspected COVID-19 infection: Observational cohort study. PLoS ONE 15(11): e0240206.

Steve Goodacre received funding from the United Kingdom National Institute for Health Research Health Technology Assessment (HTA) programme (project reference 11/46/07, The funder played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Please visit to learn about other studies that have been given urgent public health status and the single, national prioritisation process that has been established to prevent duplication of effort and to ensure that the resources and capacity of the health and care system to support COVID-19 research are not exceeded.

The National Institute for Health Research (NIHR) is the nation's largest funder of health and care research. The NIHR: The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR commissions applied health research to benefit the poorest people in low- and middle-income countries, using Official Development Assistance funding.

Competing Interests:
All authors declare grant funding to their employing institutions from the National Institute for Health Research (NIHR), as outlined under financial disclosure information. SG is Deputy Director of the NIHR Health Technology Assessment (HTA) Programme, which funded the study, and chairs the NIHR HTA commissioning committee. These competing interests do not alter our adherence to PLOS ONE policies on sharing data and materials.

In your coverage please use this URL to provide access to the freely available article in PLOS ONE:


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