Impact of COVID-19 on non-COVID intensive care unit service utilization, case mix and outcomes: A registry-based analysis from India

Wellcome Open Research

article

Neill KJ Adhikari¹  Abi Beane²  Dedeepiya Devaprasad³  Robert Fowler¹  Rashan Haniffa²  Augustian James⁴  Devachandran Jayakumar³  Chamira Kodippily⁵  Rohit Aravindakshan Kooloth³  Rakesh Laxmappa⁶  Kishore Mangal⁷  Ashwin Mani⁸  Meghena Mathew⁸  Vrindha Pari⁹  Sristi Patodia^1,10  Rajyabardhan Pattnaik^1,11  Dilanthi Priyadarshini⁵  Mathew Pulicken^1,12  Ebenezer Rabindrarajan³  Pratheema Ramachandran³  Kavita Ramesh^1,13  Usha Rani³  Ananth Ramaiyan⁹  Nagarajan Ramakrishnan⁴  Lakshmi Ranganathan⁴  Aasiyah Rashan⁵  Raymond Dominic Savio^1,10  Jaganathan Selva^1,14  Bharath Kumar Tirupakuzhi Vijayaraghavan⁴  Swagata Tripathy^1,15  Ishara Udayanga⁵  Ramesh Venkataraman⁴ 

[1] Intedepartmental Division of Critical Care Medicine, University of Toronto;Mahidol Oxford Tropical Medicine Research Unit;Department of Critical Care Medicine, Apollo Specialty Hospital;Department of Critical Care Medicine, Apollo Main Hospital;Network for Improving Critical care Systems and Training;Department of Critical Care Medicine, Nanjappa Hospital;Department of Critical Care Medicine, Eternal Hospital;Department of Critical Care Medicine, Apollo First Med Hospital;Chennai Critical Care Consultants Private Limited;Department of Critical Care Medicine, Apollo Proton Cancer Centre;Department of Critical Care Medicine, Ispat General Hospital;Department of Critical Care Medicine, Pushpagiri Medical College;Department of Critical Care Medicine, ABC Hospital;Department of Critical Care Medicine, Mehta Hospital;Department of Anaesthesia and Intensive Care Medicine, All India Institute of Medical Sciences

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

DOI  :  10.12688/wellcomeopenres.16953.2

学科分类：内科医学

来源: Wellcome

【 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 1st October 2019 and 27th 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 31st 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】

CC BY