Background: Predictors of morbidity and mortality in hospitalized COVID-19 patients have been extensively studied. However, comparative analyses of predictors for hospitalization versus discharge from the emergency department remain limited. Methods: This retrospective study evaluated predictors of hospitalization among adults (≥18 years) presenting to the emergency department with COVID-19 infection between 1 March 2020 and 15 June 2020. Data were obtained from electronic health records across five hospitals within the Johns Hopkins Health System, encompassing 2513 beds. Multivariable logistic regression models were employed to assess the association between sociodemographic characteristics, clinical symptoms, and comorbidities with hospitalization. Results: Of the 2767 patients presenting to the emergency department, 1678 (61%) were hospitalized, while 1089 (39%) were discharged from the emergency department. Hospitalized patients were older (mean age 61.8 years, SD 18), more likely to be African American and White, non-Hispanic, unemployed or on disability, medically insured, had access to primary care, and presented on weekends. Smoking status, alcohol use, and higher comorbidity burden (mean age-adjusted Charlson Comorbidity Index > 3) were also more prevalent with hospitalization. Dyspnea was a prominent clinical feature among hospitalized patients. After adjusting for sociodemographic and clinical risk factors, significant predictors of hospitalization included health insurance (OR 3.44; 95% CI: 1.98–6), having a primary care (OR 1.85; 95% CI: 1.33–2.59), presentation from a non-home locale (OR 4.04; 95% CI: 1.93–8.47), age-adjusted CCI > 3 (OR 1.72; 95% CI: 1.11–2.68), dyspnea (OR 2.22; 95% CI: 1.56–3.17), neutrophil-to-lymphocyte ratio ≥ 3 (OR 2.17; 95% CI: 1.54–3.06), and an abnormal chest radiograph findings (OR 6.17; 95% CI: 4.40–8.66). Interestingly, obesity, defined as a BMI ≥ 30 kg/m² (OR 0.45; 95% CI: 0.32–0.64), and the presence of fever (OR 0.64; 95% CI: 0.43–0.95) were found to be associated with a decreased likelihood of hospitalization. Conclusions: Future studies are warranted to further explore predictors of COVID-19 hospitalization, with particular focus on the implications of weekend presentations and the paradoxical relationship of obesity with COVID-19 health outcomes. These findings could inform the development of triage models to enhance preparedness for future pandemics.

Background. Establishing prompt vascular access facilitates resuscitation for out-of-hospital cardiac arrest (OHCA). While intraosseous access may decrease the time to vascular access, the impact on clinical outcomes in OHCA is unclear. Therefore, we aim to compare the effect of intraosseous (IO) versus intravenous (IV) vascular access on clinical outcomes after OHCA resuscitation. Methods. A systematic review and meta-analysis were performed to synthesize evidence from randomized controlled trials (RCTs) obtained from PubMed, CENTRAL, Scopus, and Web of Science until January 2025. Using Stata MP v. 17, we used the fixed-effects model to report dichotomous outcomes using the risk ratio (RR) and continuous outcomes using the mean difference (MD) with a 95% confidence interval (CI). PROSPERO ID: CRD42024627354. Results. Four RCTs and 9475 patients were included. There was no difference between both groups regarding the prehospital return of spontaneous circulation (ROSC) (RR: 0.97, 95% CI [0.91, 1.03], p = 0.33), maintained ROSC (RR: 0.94, 95% CI [0.87, 1.01], p = 0.09), survival to discharge (RR: 1.03 with 95% CI [0.88, 1.21], p = 0.71), 30-day survival (RR: 0.98, 95% CI [0.82, 1.17], p = 0.79), or favorable neurological recovery (RR: 1.07, 95% CI [0.90, 1.29], p = 0.44). However, IO access significantly increased first-attempt access (RR: 1.24, 95% CI [1.19, 1.29], p < 0.001), decreased time to vascular access (MD: −0.24 min with 95% CI [−0.48, −0.01], p = 0.04), and decreased time to drug administration (MD: −0.38, 95% CI [−0.66, −0.10], p = 0.01). Conclusions. IO and IV vascular accesses showed similar clinical outcomes in OHCA patients, with no difference in ROSC, survival, or neurological recovery. Still, IO access showed a better procedural outcome with increased first-attempt success rates, faster access, and faster drug administration.