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

TY - JOUR

T1 - Ten months of temporal variation in the clinical journey of hospitalised patients with COVID-19: An observational cohort

AU - Hall, Matthew D

AU - Baruch, Joaquín

AU - Carson, Gail

AU - Citarella, Barbara Wanjiru

AU - Dagens, Andrew

AU - Dankwa, Emmanuelle A

AU - Donnelly, Christl A

AU - Dunning, Jake

AU - Escher, Martina

AU - Kartsonaki, Christiana

AU - Merson, Laura

AU - Pritchard, Mark

AU - Wei, Jia

AU - Horby, Peter W

AU - Rojek, Amanda

AU - Olliaro, Piero L

AU - ISARIC Characterization Group

AU - Kobbe, Robin

AU - Rau, Cornelius

N1 - © 2021, ISARIC Clinical Characterisation Group et al.

PY - 2021/11/23

Y1 - 2021/11/23

N2 - Background: 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.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.

AB - Background: 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.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.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - COVID-19/therapy

KW - Child

KW - Child, Preschool

KW - Female

KW - Hospitalization/statistics & numerical data

KW - Humans

KW - Infant

KW - Intensive Care Units/statistics & numerical data

KW - Length of Stay/statistics & numerical data

KW - Male

KW - Middle Aged

KW - Outcome Assessment, Health Care/statistics & numerical data

KW - Retrospective Studies

KW - SARS-CoV-2/pathogenicity

KW - Young Adult

U2 - 10.7554/eLife.70970

DO - 10.7554/eLife.70970

M3 - SCORING: Journal article

C2 - 34812731

VL - 10

JO - ELIFE

JF - ELIFE

SN - 2050-084X

M1 - e70970

ER -