Emergency medical admissions and COVID-19: impact on 30-day mortality and hospital length of stay.

Autor: Conway RP; Department of Internal Medicine, St. James's Hospital, Dublin 8, Ireland. drrichardconway@gmail.com., Byrne DG; Department of Internal Medicine, St. James's Hospital, Dublin 8, Ireland., O'Riordan DMR; Department of Internal Medicine, St. James's Hospital, Dublin 8, Ireland., Kent BD; Department of Internal Medicine, St. James's Hospital, Dublin 8, Ireland., Kennedy BMJ; Department of Internal Medicine, St. James's Hospital, Dublin 8, Ireland., Cheallaigh CMN; Department of Internal Medicine, St. James's Hospital, Dublin 8, Ireland., O'Connell BP; Department of Internal Medicine, St. James's Hospital, Dublin 8, Ireland., Akasheh NB; Department of Internal Medicine, St. James's Hospital, Dublin 8, Ireland., Browne JG; Department of Internal Medicine, St. James's Hospital, Dublin 8, Ireland., Silke BM; Department of Internal Medicine, St. James's Hospital, Dublin 8, Ireland.
Jazyk: angličtina
Zdroj: Irish journal of medical science [Ir J Med Sci] 2022 Aug; Vol. 191 (4), pp. 1905-1911. Date of Electronic Publication: 2021 Aug 30.
DOI: 10.1007/s11845-021-02752-7
Abstrakt: Background: The COVID-19 pandemic has put considerable strain on healthcare systems.
Aim: To investigate the effect of the COVID-19 pandemic on 30-day in-hospital mortality, length of stay (LOS) and resource utilization in acute medical care.
Methods: We compared emergency medical admissions to a single secondary care centre during 2020 to the preceding 18 years (2002-2019). We investigated 30-day in-hospital mortality with a multiple variable logistic regression model. Utilization of procedures/services was related to LOS with zero truncated Poisson regression.
Results: There were 132,715 admissions in 67,185 patients over the 19-year study. There was a linear reduction in 30-day in-hospital mortality over time; over the most recent 5 years (2016-2020), there was a relative risk reduction of 36%, from 7.9 to 4.3% with a number needed to treat of 27.7. Emergency medical admissions increased 18.8% to 10,452 in 2020 with COVID-19 admissions representing 3.5%. 18.6% of COVID-19 cases required ICU admission with a median stay of 10.1 days (IQR 3.8, 16.0). COVID-19 was a significant univariate predictor of 30-day in-hospital mortality, 18.5% (95%CI: 13.9, 23.1) vs. 3.0% (95%CI: 2.7, 3.4)-OR 7.3 (95%CI: 5.3, 10.1). ICU admission was the dominant outcome predictor-OR 12.4 (95%CI: 7.7, 20.1). COVID-19 mortality in the last third of 2020 improved-OR 0.64 (95%CI: 0.47, 0.86). Hospital LOS and resource utilization were increased.
Conclusion: A diagnosis of COVID-19 was associated with significantly increased mortality and LOS but represented only 3.5% of admissions and did not attenuate the established temporal decline in overall in-hospital mortality.
(© 2021. The Author(s).)
Databáze: MEDLINE
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