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<p>The primary objective is to know how the time from symptom onset to antiviral administration (total time, TT) affects hospitalisation and death from any cause at 30&#xa0;days (composite endpoint) in patients with mild-to-moderate COVID-19 discharged from the emergency department (ED). Secondary objectives are to know how the time from ED admission to antiviral administration (hospital time, HT) modifies outcomes and whether the specialty of the prescribing physician influences these times. We conducted a nationwide, multicentre, retrospective cohort study in 16 Spanish EDs. We collected data from patients with mild-to-moderate COVID-19 who presented to an ED, received antiviral treatment, and were at risk of disease progression due to advanced age, comorbidities, or immunosuppression. We developed pooled logistic regression explanatory models to assess the association between TT, HT, and composite outcome, whilst we used quantile regression explanatory models to analyse the association between prescriber specialty and these times. All models were adjusted for confounding using inverse probability weighting. We analysed data on 534 treated patients. Longer TT was associated with worse outcomes, adjusted hazard ratio (aHR) 1,179 per day of delay, 95% confidence interval, 95% CI, 1,005 – 1,384; but no association was observed between HT and these events, aHR 1,312, 95% CI 0,900 – 1,913. Prescription by an emergency physician was associated with a reduction both in TT and in HT (adjusted median of reduction in hours, 6,78, 95% CI 0,21 – 20,65; 8,45, 95% CI 3,92 – 12,03, respectively). Earlier ED administration of antivirals for mild-to-moderate COVID-19 in vulnerable patients is associated with better clinical outcomes. Prescription by an emergency physician in the ED is also associated with shorter HT and TT.</p> Graphical Abstract <p></p>

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Time to antiviral treatment in mild–moderate COVID-19 in the emergency department: influence of prescribing physician and effect on outcomes

  • 期刊论文

  • 发表日期：

    2025年4月21日

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  • Cristóbal Manuel Rodríguez-Leal,
  • Juan González del Castillo,
  • Pere Llorens,
  • David Oteo Mata,
  • Belén Morales Franco,
  • Diana Moya Olmeda,
  • Elizabeth Ortiz García,
  • Octavio José Salmerón Béliz,
  • Anna Pons Frigola,
  • Rigoberto Jesús del Rio Navarro,
  • Hugo Martínez Faya,
  • Francisco Román Cerdán,
  • Beatriz Valle Borrego,
  • Alejandro Martin-Quirós,
  • Henrique Villena García del Real,
  • Ivana Verónica Tavasci López,
  • María Teresa Sánchez Moreno,
  • Sara Gayoso Martin,
  • Martín Sebastián Ruiz Grinspan,
  • Rosario Susi García,
  • Teresa Pérez Pérez,
  • Laura Mao Martín,
  • Gema Domínguez Gioya,
  • Noha El-Haddad Boufares,
  • Mercedes Mateas Moreno,
  • Elena Pérez Valle,
  • Rocío Martínez Avilés,
  • Sara Rodrigo González,
  • Raquel Cenjor Martín,
  • Raquel Barrós González,
  • Leocricia González Camacho,
  • Raquel Arauzo Pacheco,
  • Patricia Gantes Nieto,
  • Virginia Arroyo Linares,
  • Betty Estrella Gómez,
  • Carmen Puerta Castellano,
  • Gema Fresco Navacerrada,
  • Eloísa Delgado Torres,
  • Laura Mao Martín,
  • María Adalid Moll,
  • Francisco de Borja García Pérez,
  • María del Carmen Cutillas Benavente,
  • María Peña Macho,
  • María Galán Berasaluce,
  • Ana Rodríguez Martínez,
  • Marta Rodríguez Martínez,
  • Yaiza Hernández González Pecellín,
  • Marta Lozano Berdasco,
  • Laura Sánchez Rodríguez,
  • Ainhoa Arguedas Galindo,
  • Ana García Fernández,
  • Patricia Castro Sandoval,
  • Raquel Santos Villanueva,
  • Ana María Osuna Fernández-Baíllo,
  • Irene Iglesias Campo,
  • Rocío Gañán Morales,
  • María Teresa Torres Martín,
  • Irene Benítez Alonso,
  • María Foguet Gómez,
  • Domingo López Ovejero,
  • Lorena Sanmartín Fenollera,
  • José Luis Coperías Zazo,
  • Santiago Fernández Castelao,
  • Estrella Serrano Molina,
  • Cristina Outón González,
  • Cristóbal Luis Yang Ye,
  • Natalia Sánchez Ocaña,
  • Jerusalén Pascual Duró,
  • Pedro Pablo Bermejo Martínez,
  • Carmen Escudero Sanchez,
  • Daniel Lucas Aroca,
  • Mª José Castejón Pina,
  • Susana Hernández Abellón,
  • Marilee Galano Quiala,
  • Mª Carmen Marín Lucas,
  • Elena Martínez Carracelas,
  • María Navarro Fuentes,
  • Félix González Martínez,
  • María Esther Olvera Gallego,
  • Andrea Ruiz Romero,
  • Ana Estela Rus Ballester,
  • Alicia Cores Bartolomé,
  • Ana Virginia Espinoza Reyes,
  • Cristina Orduna Costas,
  • Cristina Valiente Prados,
  • Daniel Alonso Alvarez,
  • Diego Servidio,
  • Diana Borobio Martínez,
  • Inés Gómez Giménez,
  • Jesús Ángel Jodra Pérez,
  • Morten Aarstad Mongauge,
  • María González Fernández,
  • María Estela Chamarro Moreno,
  • Noelia Galán Iguacel,
  • Rosa María Alonso Martínez,
  • Ritika Matani Chimnani,
  • Rodrigo Javier Gil Hernández,
  • Silvia María Alconchel Gracia,
  • José Luis Benítez Mora,
  • Verónica Arely González López,
  • Miguel Moreno Herrero,
  • Isabel Jiménez Ruiz,
  • María Dolores Pardo Yanguas,
  • Rocío Sensianes Caro,
  • Julia Getino Ferreira,
  • Jorge Beltrán Hortelano,
  • Clara María Torres Ortega,
  • Arancha Escalera Suberviola,
  • José Manuel Méntrida Rodriguez,
  • Joaquín Hernández Núñez,
  • Guadalupe Pérez Nieto,
  • Rocío Salas Dueñas,
  • Marta Beneyto Arana,
  • María Ulloa Argiz,
  • Patricia Zamorano Méndez,
  • María Prada Bou,
  • Mónica Pozo Peña,
  • Ana Isabel Yuguero López,
  • Sandra Adeva Antona,
  • Irene Salvador Llana,
  • Carlos Sanz Sánchez,
  • Belén Sánchez Pascual,
  • Ana Mecina Gutiérrez,
  • Saúl Herrera Carranza,
  • Sara Álvarez Atienza,
  • María Luisa Peralta Ríos,
  • Alma Elena Real Martín,
  • Paula García Domingo,
  • Pedro José Aparicio Aragó,
  • Rosa Martin,
  • Carmen Addis Hernández,
  • Elena Martínez Morcillo,
  • María Luisa López Grima,
  • Álvaro Campo Jiménez,
  • Laura Yuste Muñoz,
  • Diana Nuevo Silva,
  • Altea Martínez Garcia,
  • Alejandro Paz Anaya,
  • Mónica Martínez Lago,
  • Vanesa Chumpitaz,
  • Blanca Riera Begue,
  • Paula Concepción Barres Fernández,
  • Javier Precioso Costa,
  • José Carbajosa Dalamau,
  • Inmaculada Jiménez Ruiz,
  • Amos Urtubia Palacios,
  • Alba Felipe Palencia,
  • Sergio Guzmán Martínez,
  • Alejandro Carratalá Ballesta,
  • Amaia Ibarra Bolt,
  • Alfonso Herrero Azpiazu,
  • Edwin Toloza Villalobos,
  • Eduardo Mediavilla Oteiza,
  • Irene Cabrera Rodrigo,
  • Guillermo Villoria Almeida,
  • Esther Álvarez Rodríguez,
  • Teresa Agudo Villa,
  • Ana M Blanco Benito,
  • María Hernández Martínez,
  • Pascual López Riquelme,
  • Rocío García Gutiérrez Gómez,
  • Julia Martínez Ibarreta Zorita,
  • Cristina Iglesias Frax,
  • Vanesa Abad Cuñado,
  • Nuria Garvín Grande,
  • Jesús Alejandro Sotomayor Contreras,
  • Victoria Achaval Rodriguez,
  • Paula Martín Borregón Bendito,
  • Mónica Martín Miguel,
  • Sara González Mano,
  • Jesús Castillo Carrillo,
  • Luis Eduardo Lander Lobariñas,
  • Cristina Domínguez Lubillo,
  • Marta Rodriguez Sanz,
  • Ana Fernández Peinado,
  • María Jesús del Río González,
  • Carlos Cañada Illana,
  • Alicia Román San Martín,
  • Francisco Moreno Ramos,
  • Elena Muñoz Val,
  • Isabel Arenas Berenguer,
  • Charbel Antonio Mauron Eid,
  • Carmen Herrero Benito,
  • Beatriz Rodríguez Fernández,
  • Cristina Rúa Castro,
  • Carmen Sandra López Seijas,
  • Sara Rial Frieiro,
  • Carlota Durán Álvarez,
  • Ana Vales Montero,
  • María Elena Carrasco Fernández,
  • Antonio Megia,
  • Beatriz Jiménez del Pulgar Gómez,
  • Edmundo Figuera Castro,
  • Laura Márquez Quero,
  • Sara Calle Fernández,
  • Francisco Diaz Miguez,
  • José Javier Noceda Bermejo,
  • Alejandro Cortés Soler,
  • Marta Valtueña Camacho,
  • Marisol Fito Suñer,
  • Sandra Latorre Villena,
  • Silvia Piza Arnau,
  • Joao Novo Matos,
  • José Fernando Madrigal Valdés,
  • Francisco Javier Favá García,
  • Elena Velasco Prats,
  • Olga Jiménez Alfonso,
  • Miguel Ángel Huerta Fernández,
  • Verónica Castillo Gómez,
  • Luján Llorente Santiago,
  • Alia Eworo,
  • Ana Aymerich Sánchez,
  • Elena M Castro Pérez,
  • Elena López Garzón,
  • Irama Carolina González Araujo

摘要

The primary objective is to know how the time from symptom onset to antiviral administration (total time, TT) affects hospitalisation and death from any cause at 30 days (composite endpoint) in patients with mild-to-moderate COVID-19 discharged from the emergency department (ED). Secondary objectives are to know how the time from ED admission to antiviral administration (hospital time, HT) modifies outcomes and whether the specialty of the prescribing physician influences these times. We conducted a nationwide, multicentre, retrospective cohort study in 16 Spanish EDs. We collected data from patients with mild-to-moderate COVID-19 who presented to an ED, received antiviral treatment, and were at risk of disease progression due to advanced age, comorbidities, or immunosuppression. We developed pooled logistic regression explanatory models to assess the association between TT, HT, and composite outcome, whilst we used quantile regression explanatory models to analyse the association between prescriber specialty and these times. All models were adjusted for confounding using inverse probability weighting. We analysed data on 534 treated patients. Longer TT was associated with worse outcomes, adjusted hazard ratio (aHR) 1,179 per day of delay, 95% confidence interval, 95% CI, 1,005 – 1,384; but no association was observed between HT and these events, aHR 1,312, 95% CI 0,900 – 1,913. Prescription by an emergency physician was associated with a reduction both in TT and in HT (adjusted median of reduction in hours, 6,78, 95% CI 0,21 – 20,65; 8,45, 95% CI 3,92 – 12,03, respectively). Earlier ED administration of antivirals for mild-to-moderate COVID-19 in vulnerable patients is associated with better clinical outcomes. Prescription by an emergency physician in the ED is also associated with shorter HT and TT.

Graphical Abstract