Version 1
: Received: 10 August 2020 / Approved: 11 August 2020 / Online: 11 August 2020 (13:45:43 CEST)
Version 2
: Received: 8 September 2020 / Approved: 9 September 2020 / Online: 9 September 2020 (09:28:49 CEST)
How to cite:
Doidge, J. C.; Mouncey, P. R.; Thomas, K.; Gould, D. W.; Ferrando-Vivas, P.; Shankar-Hari, M.; Harrison, D. A.; Rowan, K. M. Trends in Intensive Care for Patients with COVID-19 in England, Wales and Northern Ireland. Preprints2020, 2020080267. https://doi.org/10.20944/preprints202008.0267.v2
Doidge, J. C.; Mouncey, P. R.; Thomas, K.; Gould, D. W.; Ferrando-Vivas, P.; Shankar-Hari, M.; Harrison, D. A.; Rowan, K. M. Trends in Intensive Care for Patients with COVID-19 in England, Wales and Northern Ireland. Preprints 2020, 2020080267. https://doi.org/10.20944/preprints202008.0267.v2
Doidge, J. C.; Mouncey, P. R.; Thomas, K.; Gould, D. W.; Ferrando-Vivas, P.; Shankar-Hari, M.; Harrison, D. A.; Rowan, K. M. Trends in Intensive Care for Patients with COVID-19 in England, Wales and Northern Ireland. Preprints2020, 2020080267. https://doi.org/10.20944/preprints202008.0267.v2
APA Style
Doidge, J. C., Mouncey, P. R., Thomas, K., Gould, D. W., Ferrando-Vivas, P., Shankar-Hari, M., Harrison, D. A., & Rowan, K. M. (2020). Trends in Intensive Care for Patients with COVID-19 in England, Wales and Northern Ireland. Preprints. https://doi.org/10.20944/preprints202008.0267.v2
Chicago/Turabian Style
Doidge, J. C., David A Harrison and Kathryn M Rowan. 2020 "Trends in Intensive Care for Patients with COVID-19 in England, Wales and Northern Ireland" Preprints. https://doi.org/10.20944/preprints202008.0267.v2
Abstract
Rationale:Examining trends in patient characteristics, processes of care and outcomes, across an epidemic, provides important opportunities for learning. Objectives: To report and explore changes in admission rates, patient characteristics, processes of care and outcomes for all patients with COVID-19 admitted to intensive care units (ICUs) in England, Wales and Northern Ireland. Methods: Population cohort of 10,287 patients with COVID-19 in the Case Mix Programme national clinical audit from 1 February to 2 July, 2020. Analyses were stratified by time period (pre-peak, peak, post-peak) and geographical region. Multivariable logistic regression was used to estimate differences in 28-day mortality, adjusting for patient characteristics over time. Main results: Admissions to ICU peaked simultaneously across regions on 1 April, with ongoing admissions peaking ten days later. Compared with pre- and post-peak periods, patients admitted during the peak were slightly younger but had greater respiratory and renal dysfunction. Use of invasive ventilation and renal replacement reduced over time. Twenty-eight-day mortality reduced from 43.5% (95% CI 41.6% to 45.5%) pre-peak to 34.3% (95% CI 32.3% to 36.2%) post-peak; a difference of −8.8% (95% CI: −5.2%, −12.3%) after adjusting for patient characteristics. London experienced the highest admission rate and had higher mortality during the peak period but a greater reduction in post-peak mortality. Conclusion: This study highlights changes in patient characteristics, processes of care and outcomes, during the UK COVID-19 epidemic. After adjusting for the changes in patient characteristics and first 24-hour physiology, there was substantial improvement in 28-day mortality over the course of the epidemic.
Keywords
COVID-19; intensive care; trends; United Kingdom; mortality; mechanical ventilation
Subject
Medicine and Pharmacology, Pulmonary and Respiratory Medicine
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Commenter: David Harrison
Commenter's Conflict of Interests: Author