The following is a summary of “Association between patient-reported onset-to-door time and mortality in patients hospitalized with COVID-19 disease,” published in the March 2024 issue of Emergency Medicine by Yadav, et al.

The timely presentation and treatment of coronavirus disease (COVID-19) are crucial for patient recovery. However, understanding the relationship between symptom onset to hospital arrival (symptom onset-to-door time, ODT) and key clinical outcomes, such as inpatient mortality, has been challenging due to the difficulty of retrospectively measuring symptom onset in observational data. For a study, researchers sought to investigate the association between patient-reported ODT and mortality among hospitalized patients with COVID-19.

A retrospective cohort study was conducted on emergency department (ED) encounters of patients with COVID-19 who were hospitalized and received remdesivir and/or dexamethasone between March 1, 2020, and March 1, 2022. Patient-reported ODT in days served as the exposure, while inpatient mortality, including referral to hospice care, was the outcome of interest. Multivariable logistic regression was employed to assess the association between ODT and mortality while adjusting for patient characteristics, hospital sites, and seasonality. Additionally, the study explored whether the severity of illness upon hospital presentation modified the ODT-mortality association, with severe illness defined by specific criteria.

Among the 3,451 ED hospitalizations analyzed, 439 (12.7%) resulted in mortality, with 1,693 (49.1%) involving patients with severe illness upon hospital presentation. A longer ODT was significantly associated with lower odds of inpatient mortality (adjusted odds ratio [AOR] = 0.96, 95% CI = 0.93–1.00, P = 0.023). Furthermore, there was a significant interaction between ODT and severe illness at hospital arrival on mortality, indicating that the negative association between ODT and mortality applied primarily to patients without severe illness at ED presentation (AOR = 0.93, 95% CI = 0.87–1.00, P = 0.035). Specifically, the adjusted probability of mortality was significantly lower for non-severely ill hospitalized patients who presented on days 8–14 after symptom onset compared to those presenting on days 0–3.

Among hospitalized patients with COVID-19, a longer time between symptom onset and hospital arrival was associated with lower mortality, especially for those without severe illness upon ED presentation. However, ODT was not associated with mortality among hospitalized patients with severe illness at ED presentation. The findings suggested that non-severely ill patients with COVID-19 requiring hospitalization are less likely to experience deterioration with each passing day without severe illness. The insights can inform clinical care delivery for hospitalized patients with COVID-19.

Reference: sciencedirect.com/science/article/abs/pii/S0735675723006575