Impact of COVID-19 on non-COVID intensive care unit service utilization, case mix and outcomes: A registry-based analysis from India [version 2; peer review: 2 approved]

Wellcome Open Research

卷:6

Vrindha Pari¹  Ananth Ramaiyan¹  Swagata Tripathy²  Kavita Ramesh³  Meghena Mathew⁴  Ashwin Mani⁴  Nagarajan Ramakrishnan⁵  Bharath Kumar Tirupakuzhi Vijayaraghavan⁵  Augustian James⁵  Lakshmi Ranganathan⁵  Ramesh Venkataraman⁵  Raymond Dominic Savio⁶  Sristi Patodia⁶  Ebenezer Rabindrarajan⁷  Devachandran Jayakumar⁷  Pratheema Ramachandran⁷  Usha Rani⁷  Rohit Aravindakshan Kooloth⁷  Dedeepiya Devaprasad⁷  Kishore Mangal⁸  Rajyabardhan Pattnaik⁹  Jaganathan Selva¹⁰  Rakesh Laxmappa¹¹  Mathew Pulicken¹²  Neill KJ Adhikari¹³  Robert Fowler¹³  Rashan Haniffa¹⁴  Abi Beane¹⁴  Dilanthi Priyadarshini¹⁵  Chamira Kodippily¹⁵  Aasiyah Rashan¹⁵  Ishara Udayanga¹⁵ 

[1] Chennai Critical Care Consultants Private Limited, Chennai, India;

[2] Department of Anaesthesia and Intensive Care Medicine, All India Institute of Medical Sciences, Bhubaneswar, India;

[3] Department of Critical Care Medicine, ABC Hospital, Vishakapatnam, India;

[4] Department of Critical Care Medicine, Apollo First Med Hospital, Chennai, India;

[5] Department of Critical Care Medicine, Apollo Main Hospital, Chennai, India;

[6] Department of Critical Care Medicine, Apollo Proton Cancer Centre, Chennai, India;

[7] Department of Critical Care Medicine, Apollo Specialty Hospital, Chennai, India;

[8] Department of Critical Care Medicine, Eternal Hospital, Jaipur, India;

[9] Department of Critical Care Medicine, Ispat General Hospital, Rourkela, India;

[10] Department of Critical Care Medicine, Mehta Hospital, Chennai, India;

[11] Department of Critical Care Medicine, Nanjappa Hospital, Shimoga, India;

[12] Department of Critical Care Medicine, Pushpagiri Medical College, Tiruvalla, India;

[13] Intedepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada;

[14] Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand;

[15] Network for Improving Critical care Systems and Training, Colombo, Sri Lanka;

关键词: COVID-19;    registries;    critical care;    severity of illness;    eng;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background: Coronavirus disease 2019 (COVID-19) has been responsible for over 3.4 million deaths globally and over 25 million cases in India. As part of the response, India imposed a nation-wide lockdown and prioritized COVID-19 care in hospitals and intensive care units (ICUs). Leveraging data from the Indian Registry of IntenSive care, we sought to understand the impact of the COVID-19 pandemic on critical care service utilization, case-mix, and clinical outcomes in non-COVID ICUs.  Methods: We included all consecutive patients admitted between 1 st October 2019 and 27 th September 2020. Data were extracted from the registry database and included patients admitted to the non-COVID or general ICUs at each of the sites. Outcomes included measures of resource-availability, utilisation, case-mix, acuity, and demand for ICU beds. We used a Mann-Whitney test to compare the pre-pandemic period (October 2019 - February 2020) to the pandemic period (March-September 2020). In addition, we also compared the period of intense lockdown (March-May 31 st 2020) with the pre-pandemic period. Results: There were 3424 patient encounters in the pre-pandemic period and 3524 encounters in the pandemic period. Comparing these periods, weekly admissions declined (median [Q1 Q3] 160 [145,168] to 113 [98.5,134]; p<0.001); unit turnover declined (median [Q1 Q3] 12.1 [11.32,13] to 8.58 [7.24,10], p<0.001), and APACHE II score increased (median [Q1 Q3] 19 [19,20] to 21 [20,22] ; p<0.001). Unadjusted ICU mortality increased (9.3% to 11.7%, p=0.015) and the length of ICU stay was similar (median [Q1 Q3] 2.11 [2, 2] vs. 2.24 [2, 3] days; p=0.151). Conclusion: Our registry-based analysis of the impact of COVID-19 on non-COVID critical care demonstrates significant disruptions to healthcare utilization during the pandemic and an increase in the severity of illness.

【 授权许可】

Unknown