Ten months of temporal variation in the clinical journey of hospitalised patients with COVID-19: An observational cohort.

Adolescent Adult Aged Aged, 80 and over COVID-19 / therapy Child Child, Preschool Female Hospitalization / statistics & numerical data Humans Infant Intensive Care Units / statistics & numerical data Length of Stay / statistics & numerical data Male Middle Aged Outcome Assessment, Health Care / statistics & numerical data Retrospective Studies SARS-CoV-2 / pathogenicity Young Adult

COVID-19 ICU SARS-CoV-2 epidemiology global health hospitalisation human medicine viruses

Journal

eLife

ISSN: 2050-084X

Titre abrégé: Elife

Pays: England

ID NLM: 101579614

Informations de publication

Date de publication:
23 11 2021

Historique:

received: 03 06 2021

accepted: 18 11 2021

pubmed: 24 11 2021

medline: 8 2 2022

entrez: 23 11 2021

Statut: epublish

Résumé

There is potentially considerable variation in the nature and duration of the care provided to hospitalised patients during an infectious disease epidemic or pandemic. Improvements in care and clinician confidence may shorten the time spent as an inpatient, or the need for admission to an intensive care unit (ICU) or high dependency unit (HDU). On the other hand, limited resources at times of high demand may lead to rationing. Nevertheless, these variables may be used as static proxies for disease severity, as outcome measures for trials, and to inform planning and logistics. We investigate these time trends in an extremely large international cohort of 142,540 patients hospitalised with COVID-19. Investigated are: time from symptom onset to hospital admission, probability of ICU/HDU admission, time from hospital admission to ICU/HDU admission, hospital case fatality ratio (hCFR) and total length of hospital stay. Time from onset to admission showed a rapid decline during the first months of the pandemic followed by peaks during August/September and December 2020. ICU/HDU admission was more frequent from June to August. The hCFR was lowest from June to August. Raw numbers for overall hospital stay showed little variation, but there is clear decline in time to discharge for ICU/HDU survivors. Our results establish that variables of these kinds have limitations when used as outcome measures in a rapidly evolving situation. This work was supported by the UK Foreign, Commonwealth and Development Office and Wellcome [215091/Z/18/Z] and the Bill & Melinda Gates Foundation [OPP1209135]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Sections du résumé

Background

Methods

We investigate these time trends in an extremely large international cohort of 142,540 patients hospitalised with COVID-19. Investigated are: time from symptom onset to hospital admission, probability of ICU/HDU admission, time from hospital admission to ICU/HDU admission, hospital case fatality ratio (hCFR) and total length of hospital stay.

Results

Time from onset to admission showed a rapid decline during the first months of the pandemic followed by peaks during August/September and December 2020. ICU/HDU admission was more frequent from June to August. The hCFR was lowest from June to August. Raw numbers for overall hospital stay showed little variation, but there is clear decline in time to discharge for ICU/HDU survivors.

Conclusions

Our results establish that variables of these kinds have limitations when used as outcome measures in a rapidly evolving situation.

Funding

This work was supported by the UK Foreign, Commonwealth and Development Office and Wellcome [215091/Z/18/Z] and the Bill & Melinda Gates Foundation [OPP1209135]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Identifiants

DOI: 10.7554/eLife.70970 PMID: 34812731 PMC: PMC8791638

pubmed: 34812731

doi: 10.7554/eLife.70970

pii: 70970

pmc: PMC8791638

doi:

pii:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation