Department of Emergency Medicine, Rennaissance School of Medicine, Stony Brook University, Stony Brook, NY.
Department of Emergency Medicine, Rennaissance School of Medicine, Stony Brook University, Stony Brook, NY.
Ann Emerg Med. 2020 Oct;76(4):394-404. doi: 10.1016/j.annemergmed.2020.05.011. Epub 2020 May 11.
Most coronavirus disease 2019 (COVID-19) reports have focused on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive patients. However, at initial presentation, most patients' viral status is unknown. Determination of factors that predict initial and subsequent need for ICU and invasive mechanical ventilation is critical for resource planning and allocation. We describe our experience with 4,404 persons under investigation and explore predictors of ICU care and invasive mechanical ventilation at a New York COVID-19 epicenter.
We conducted a retrospective cohort study of all persons under investigation and presenting to a large academic medical center emergency department (ED) in New York State with symptoms suggestive of COVID-19. The association between patient predictor variables and SARS-CoV-2 status, ICU admission, invasive mechanical ventilation, and mortality was explored with univariate and multivariate analyses.
Between March 12 and April 14, 2020, we treated 4,404 persons under investigation for COVID-19 infection, of whom 68% were discharged home, 29% were admitted to a regular floor, and 3% to an ICU. One thousand six hundred fifty-one of 3,369 patients tested have had SARS-CoV-2-positive results to date. Of patients with regular floor admissions, 13% were subsequently upgraded to the ICU after a median of 62 hours (interquartile range 28 to 106 hours). Fifty patients required invasive mechanical ventilation in the ED, 4 required out-of-hospital invasive mechanical ventilation, and another 167 subsequently required invasive mechanical ventilation in a median of 60 hours (interquartile range 26 to 99) hours after admission. Testing positive for SARS-CoV-2 and lower oxygen saturations were associated with need for ICU and invasive mechanical ventilation, and with death. High respiratory rates were associated with the need for ICU care.
Persons under investigation for COVID-19 infection contribute significantly to the health care burden beyond those ruling in for SARS-CoV-2. For every 100 admitted persons under investigation, 9 will require ICU stay, invasive mechanical ventilation, or both on arrival and another 12 within 2 to 3 days of hospital admission, especially persons under investigation with lower oxygen saturations and positive SARS-CoV-2 swab results. This information should help hospitals manage the pandemic efficiently.
大多数关于 2019 年冠状病毒病（COVID-19）的报告都集中在严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）阳性患者上。然而，在最初表现时，大多数患者的病毒状态尚不清楚。确定预测初始和后续需要重症监护病房（ICU）和有创机械通气的因素对于资源规划和分配至关重要。我们描述了在纽约 COVID-19 中心对 4404 名待调查者的经验，并探讨了预测 ICU 治疗和有创机械通气的因素。
我们对所有在纽约州一家大型学术医疗中心急诊科出现 COVID-19 症状的待调查者进行了回顾性队列研究。使用单变量和多变量分析探讨了患者预测变量与 SARS-CoV-2 状态、入住 ICU、有创机械通气和死亡率之间的关系。
在 2020 年 3 月 12 日至 4 月 14 日期间，我们共治疗了 4404 名 COVID-19 感染待调查者，其中 68%出院回家，29%入住普通病房，3%入住 ICU。截至目前，在 3369 名接受检测的患者中，有 1651 名 SARS-CoV-2 检测结果呈阳性。在普通病房住院的患者中，13%在中位数为 62 小时（28 至 106 小时）后升级到 ICU。50 名患者在急诊科需要有创机械通气，4 名需要院外有创机械通气，另外 167 名患者在中位数为 60 小时（26 至 99 小时）后需要有创机械通气在住院后。SARS-CoV-2 检测阳性和较低的血氧饱和度与需要 ICU 和有创机械通气以及死亡相关。高呼吸频率与需要 ICU 护理相关。
COVID-19 感染待调查者对医疗保健负担的贡献远远超过了 SARS-CoV-2 的确诊患者。每 100 名入院待调查者中，有 9 人在入院时需要 ICU 入住、有创机械通气或两者兼有，另有 12 人在入院后 2 至 3 天内需要上述治疗，尤其是血氧饱和度较低和 SARS-CoV-2 拭子检测结果阳性的待调查者。这些信息应该有助于医院有效地管理大流行。
