NYU Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, Division of Critical Care, New York, New York.
NYU Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New York.
West J Emerg Med. 2022 Nov 1;23(6):907-912. doi: 10.5811/westjem.2022.8.57035.
Coronavirus 2019 (COVID-19) illness continues to affect national and global hospital systems, with a particularly high burden to intensive care unit (ICU) beds and resources. It is critical to identify patients who initially do not require ICU resources but subsequently rapidly deteriorate. We investigated patient populations during COVID-19 at times of full or near-full (surge) and non-full (non-surge) hospital capacity to determine the effect on those who may need a higher level of care or deteriorate quickly, defined as requiring a transfer to ICU within 24 hours of admission to a non-ICU level of care, and to provide further knowledge on this high-risk group of patients.
This was a retrospective cohort study of a single health system comprising four emergency departments and three tertiary hospitals in New York, NY, across two different time periods (during surge and non-surge inpatient volume times during the COVID-19 pandemic). We queried the electronic health record for all patients admitted to a non-ICU setting with unexpected ICU transfer (UIT) within 24 hours of admission. We then made a comparison between adult patients with confirmed coronavirus 2019 and without during surge and non-surge time periods.
During the surge period, there was a total of 86 UITs in a one-month period. Of those, 60 were COVID-19 positive patients who had a mortality rate of 63.3%, and 26 were COVID-19 negative with a 30.8 % mortality rate. During the non-surge period, there was a total of 112 UITs; of those, 24 were COVID-19 positive with a 37.5% mortality rate, and 90 were COVID-19 negative with a 11.1% mortality rate.
During the surge, the mortality rate for both COVID-19 positive and COVID-19 negative patients experiencing an unexpected ICU transfer was significantly higher.
2019 年冠状病毒病（COVID-19）仍在继续影响着国家和全球的医院系统，对重症监护病房（ICU）床位和资源造成了特别大的负担。识别那些最初不需要 ICU 资源但随后迅速恶化的患者至关重要。我们调查了 COVID-19 大流行期间医院满负荷或接近满负荷（高峰）和非满负荷（非高峰）时的患者人群，以确定对那些可能需要更高水平护理或迅速恶化的患者的影响，这些患者被定义为在非 ICU 级别的护理入院后 24 小时内需要转入 ICU，为这一高危患者群体提供进一步的知识。
这是一项回顾性队列研究，涉及纽约州纽约市的一个单一医疗系统，包括四个急诊科和三个三级医院，跨越 COVID-19 大流行期间的两个不同时间段（高峰和非高峰住院量期间）。我们在电子病历中查询了所有在非 ICU 环境中入院但在入院后 24 小时内意外转入 ICU（UIT）的患者。然后，我们在高峰和非高峰时段比较了确诊为 2019 年冠状病毒病和未确诊的成年患者。
在高峰期间，一个月内共有 86 例 UIT。其中，60 例是 COVID-19 阳性患者，死亡率为 63.3%，26 例是 COVID-19 阴性患者，死亡率为 30.8%。在非高峰期间，总共有 112 例 UIT；其中，24 例 COVID-19 阳性患者死亡率为 37.5%，90 例 COVID-19 阴性患者死亡率为 11.1%。
在高峰期，COVID-19 阳性和 COVID-19 阴性患者经历意外 ICU 转移的死亡率都显著更高。
