Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
Department of Biomedical Informatics, Columbia University Irving Medical Center, 622 West 168th Street, PH-20, New York, NY 10032, USA.
BMJ. 2020 May 29;369:m1996. doi: 10.1136/bmj.m1996.
To characterize patients with coronavirus disease 2019 (covid-19) in a large New York City medical center and describe their clinical course across the emergency department, hospital wards, and intensive care units.
Retrospective manual medical record review.
NewYork-Presbyterian/Columbia University Irving Medical Center, a quaternary care academic medical center in New York City.
The first 1000 consecutive patients with a positive result on the reverse transcriptase polymerase chain reaction assay for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who presented to the emergency department or were admitted to hospital between 1 March and 5 April 2020. Patient data were manually abstracted from electronic medical records.
Characterization of patients, including demographics, presenting symptoms, comorbidities on presentation, hospital course, time to intubation, complications, mortality, and disposition.
Of the first 1000 patients, 150 presented to the emergency department, 614 were admitted to hospital (not intensive care units), and 236 were admitted or transferred to intensive care units. The most common presenting symptoms were cough (732/1000), fever (728/1000), and dyspnea (631/1000). Patients in hospital, particularly those treated in intensive care units, often had baseline comorbidities including hypertension, diabetes, and obesity. Patients admitted to intensive care units were older, predominantly male (158/236, 66.9%), and had long lengths of stay (median 23 days, interquartile range 12-32 days); 78.0% (184/236) developed acute kidney injury and 35.2% (83/236) needed dialysis. Only 4.4% (6/136) of patients who required mechanical ventilation were first intubated more than 14 days after symptom onset. Time to intubation from symptom onset had a bimodal distribution, with modes at three to four days, and at nine days. As of 30 April, 90 patients remained in hospital and 211 had died in hospital.
Patients admitted to hospital with covid-19 at this medical center faced major morbidity and mortality, with high rates of acute kidney injury and inpatient dialysis, prolonged intubations, and a bimodal distribution of time to intubation from symptom onset.
在一家大型纽约市医疗中心描述患有 2019 年冠状病毒病（COVID-19）的患者，并描述他们在急诊科、医院病房和重症监护病房的临床过程。
回顾性手动病历审查。
纽约长老会/哥伦比亚大学欧文医学中心，一家位于纽约市的四级保健学术医疗中心。
首位在 2020 年 3 月 1 日至 4 月 5 日期间到急诊科就诊或住院的经逆转录酶聚合酶链反应检测 SARS-CoV-2 呈阳性的 1000 例连续患者。从电子病历中手动提取患者数据。
患者特征，包括人口统计学、就诊症状、就诊时的合并症、住院过程、插管时间、并发症、死亡率和出院情况。
在最初的 1000 名患者中，有 150 人到急诊科就诊，614 人住院（非重症监护病房），236 人转入或转入重症监护病房。最常见的就诊症状是咳嗽（732/1000）、发热（728/1000）和呼吸困难（631/1000）。住院患者，尤其是重症监护病房的患者，常有高血压、糖尿病和肥胖等基础合并症。转入重症监护病房的患者年龄较大，主要为男性（158/236，66.9%），住院时间较长（中位数为 23 天，四分位间距为 12-32 天）；78.0%（184/236）发生急性肾损伤，35.2%（83/236）需要透析。仅 4.4%（6/136）需要机械通气的患者从症状发作到插管的时间超过 14 天。从症状发作到插管的时间呈双峰分布，模式为 3 至 4 天和 9 天。截至 4 月 30 日，仍有 90 名患者住院，211 名患者在医院死亡。
在该医疗中心，因 COVID-19 住院的患者面临严重的发病率和死亡率，急性肾损伤和住院透析率高，插管时间延长，且从症状发作到插管的时间呈双峰分布。
