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382 Can Pre-Morbid Echocardiography, Beyond Clinical Risk Factors, Predict Need for Hospitalizing in COVID-19 Patients?

Study Objective: Age and medical co-morbidities are well-known risk factors for need for hospitalization in COVID-19. It is unclear whether, and which, baseline echocardiographic abnormalities may refine triage in the emergency department beyond clinical risk factors, and hence help identify patients at higher risk for need for hospitalization. We aimed to investigate echocardiographic variables associated with risk of hospitalization in COVID-19 patients. Methods: Electronic health records (EHR) were screened retrospectively to identify adults with a positive COVID-19 test throughout St. Luke’s University Health Network from March 1, 2020-October 31, 2020, and had a transthoracic echocardiogram (TTE) within 15-180 days prior. Baseline medical co-morbidities and echocardiographic variables were compared between patients stratified by hospitalization. Continuous variables were compared using Student’s t-test or Mann-Whitney U-test;categorical variables using the χ 2-test or Fisher’s Exact test. Univariate logistic regression was used to select significant predictors for multivariate analysis. Backward stepwise logistic regression was performed to identify predictors of need for hospitalization, a surrogate for mild versus moderate-severe disease. Results: 193 patients met inclusion criteria (83 hospitalized). Mean TTE to COVID19 positivity time was 86±52 days. Hospitalized patients were older and more likely to suffer co-morbidities (Table 1). Age, medical co-morbidities and several echocardiographic variables predicted need for hospitalization. Multivariate analysis revealed age, coronary disease, COPD, and left atrial (LA) enlargement (≥4 cm) independently predicting hospitalization with excellent discrimination (AUC 0.809, figure 1). Estimates plots are depicted in Figure 2. Conclusion: We present, to our knowledge the first cohort indicating that LA enlargement, in a largely unselected population, is an independent marker of need for hospitalization (a surrogate for worse than mild disease) among COVID-19 patients, and could perhaps be considered in addition to clinical risk assessment in the ED, when available. Being “upstream” from the left ventricle (LV), LA enlargement is an indicator of sustained LV pressure and/or volume overload resulting from diverse etiologies, including hypertension, valvular heart disease, and ischemic heart disease. Hence, LA size has long been known to be an independent predictor of cardiovascular events, stroke, and all-cause mortality among patients with underlying cardiovascular disease as well as the general population. Importantly, LA diameter emerged as a more powerful predictor than LV hypertrophy of COVID-19 severity, as indicated by need for hospitalization. [Formula presented] [Formula presented] [Formula presented]

Conclusions: Of various ocular emergencies in which advanced neuroimaging was not required, conjunctivitis and retinal detachment were the most common causes of unnecessary imaging. Imaging was necessary for most patients with final diagnoses of trauma and neurologic disorders. CT was the most common type of imaging modality performed. Study Objectives: The diagnosis and treatment of mild traumatic brain injuries (mTBI) by physicians in the emergency department (ED) is greatly varied. Due to the frequency and long term consequences associated with pediatric head injuries, it is crucial that adequate counseling is provided in acute care settings along with uniform terminology for understanding. Currently, at many institutions including Loyola University Medical Center (LUMC), there are no uniform guidelines set in place for the treatment of mTBI in pediatric patients in the ED. The purpose of our study is to evaluate existing practices at LUMC ED in order to address inconsistencies in diagnostic or discharge practices for the implementation of future quality improvement measures.
Methods: A retrospective cohort study was conducted at LUMC of pediatric patient records from 2017 to 2020 for patients presenting with mTBI. A total of 1,160 patients aged 2 to 18 met inclusion criteria for analysis. Demographic, diagnostic, and treatment data were summarized, and Pearson's chi squared tests and Fisher's exact tests were performed to determine associations among patient characteristics and provider practices.
Results: The common etiologies of injury included sports related contact injuries (24.7%) and falls (20.1%). In terms of evaluation, physicians did not uniformly use existing criteria such as PECARN to determine if CT scans were needed (31.6% did not use). However, there was correlation of utilizing this diagnostic tool with fallrelated injuries compared to other injury types (39.5%, p<0.001). Regarding treatment, discharge instructions were predominantly based on a generalized template on Epic (91.9%), with a minority of physicians providing additional specific instructions to the patient through written, verbal, or additional supplemental material. The most common formats included Epic only (46.1%), Epic and personalized written instructions (20.2%), and Epic and verbal instructions (12.4%). When provided, specific instructions were correlated with the injuries involving motor vehicles accidents (p¼0.001). Instructions for follow-up within 3 months of ED visit were provided to 93% of patients who received discharged instructions and were for primary care (96.7%), sports medicine (1.58%), neurology (0.65%), or other providers (1.11%).
Conclusions: There is a lack of consistency in the evaluation and treatment of mTBI in pediatric patients in the LUMC ED. There is a need for guidelines to be set forth in order to ensure adequate patient (or parent) compliance and understanding. More emphasis must be placed on providing educational resources and ensuring appropriate follow-up care for patients, not only to help them manage an existing mTBI, but also to prevent long-term consequences from occurring. Further studies looking at long-term outcomes in these patients would also be beneficial.  Study Objective: Age and medical co-morbidities are well-known risk factors for need for hospitalization in COVID-19. It is unclear whether, and which, baseline echocardiographic abnormalities may refine triage in the emergency department beyond clinical risk factors, and hence help identify patients at higher risk for need for hospitalization. We aimed to investigate echocardiographic variables associated with risk of hospitalization in COVID-19 patients.
Methods: Electronic health records (EHR) were screened retrospectively to identify adults with a positive COVID-19 test throughout St. Luke's University Health Network from March 1, 2020-October 31, 2020, and had a transthoracic echocardiogram (TTE) within 15-180 days prior. Baseline medical co-morbidities and echocardiographic variables were compared between patients stratified by hospitalization. Continuous variables were compared using Student's t-test or Mann-Whitney U-test; categorical variables using the c 2-test or Fisher's Exact test. Univariate logistic regression was used to select significant predictors for multivariate analysis. Backward stepwise logistic regression was performed to identify predictors of need for hospitalization, a surrogate for mild versus moderatesevere disease.
Results: 193 patients met inclusion criteria (83 hospitalized). Mean TTE to COVID19 positivity time was 86AE52 days. Hospitalized patients were older and more likely to suffer co-morbidities (Table 1). Age, medical co-morbidities and several echocardiographic variables predicted need for hospitalization. Multivariate analysis revealed age, coronary disease, COPD, and left atrial (LA) enlargement (!4 cm) independently predicting hospitalization with excellent discrimination (AUC 0.809, figure 1). Estimates plots are depicted in Figure 2.
Conclusion: We present, to our knowledge the first cohort indicating that LA enlargement, in a largely unselected population, is an independent marker of need for hospitalization (a surrogate for worse than mild disease) among COVID-19 patients, and could perhaps be considered in addition to clinical risk assessment in the ED, when available. Being "upstream" from the left ventricle (LV), LA enlargement is an indicator of sustained LV pressure and/or volume overload resulting from diverse etiologies, including hypertension, valvular heart disease, and ischemic heart disease. Hence, LA size has long been known to be an independent predictor of cardiovascular events, stroke, and all-cause mortality among patients with underlying cardiovascular disease as well as the general population. Importantly, LA diameter emerged as a more powerful predictor than LV hypertrophy of COVID-19 severity, as indicated by need for hospitalization.