Toss Agegård Lina, Berggren Karin, Cronhjort Maria, Joelsson-Alm Eva, Sackey Peter, Jonmarker Sandra, Schandl Anna Regina
Department of Perioperative and Intensive care Södersjukhuset, Stockholm, Sweden.
Department of Perioperative and Intensive care Södersjukhuset, Stockholm, Sweden
BMJ Open. 2025 Feb 18;15(2):e090952. doi: 10.1136/bmjopen-2024-090952.
This study aimed to compare mortality rates and length of hospital stay between patients with critical COVID-19 transferred to another hospital due to capacity constraints and those who remained at their initial admission hospital.
Single-centre cohort study.
665 patients were treated for SARS-CoV-2 at two intensive care units (ICUs) in Stockholm, Sweden, from 1 March 2020 to 30 June 2021. Data on interhospital transfers (IHTs) were retrieved from medical records and patient data management systems according to predefined protocols.
The outcomes were 30-day and 90-day mortality, days alive and out of ICU. HR with 95% CI were calculated using Cox proportional hazard models with adjustments for age, sex, body mass index, severity of illness, comorbidity, invasive ventilation, treatment limitations and pandemic waves.
Of 665 patients, 133 (20%) were transferred to another hospital. The mortality rate of transferred patients compared with non-transferred patients at 30 days was 19% vs 26% (p=0.13) and at 90 days 26% vs 30% (p=0.43). In the adjusted Cox regression analysis, IHT was associated with a lower mortality risk at 30 days (HR 0.47, 95% CI 0.30 to 0.76) and 90 days (HR 0.52, 95% CI 0.34 to 0.79). However, the number of days alive and out of ICU was significantly lower for the IHT group at 30 days.
In our study, IHT due to capacity constraints among critically ill COVID-19 patients was not associated with a higher mortality risk. The suitability for transfer was likely associated with lower mortality, although residual confounding cannot be ruled out. The requirement for invasive ventilation among transferred patients might account for the extended length of ICU stay, rather than the transfer itself. However, the difficulty in studying this issue lies in the fact that while patients are likely exposed to risks during transfer, they are simultaneously the patients stable enough to be transported.
本研究旨在比较因容量限制转至另一家医院的重症新型冠状病毒肺炎（COVID-19）患者与留在初始收治医院的患者之间的死亡率和住院时间。
单中心队列研究。
2020年3月1日至2021年6月30日期间，瑞典斯德哥尔摩的两个重症监护病房（ICU）对665例感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的患者进行了治疗。根据预定义方案，从病历和患者数据管理系统中检索院间转运（IHT）数据。
结局指标为30天和90天死亡率、存活且转出ICU的天数。采用Cox比例风险模型计算95%置信区间（CI）的风险比（HR），并对年龄、性别、体重指数、疾病严重程度、合并症、有创通气、治疗限制和疫情波次进行调整。
665例患者中，133例（20%）转至另一家医院。转院患者与未转院患者相比，30天时的死亡率分别为19%和26%（p=0.13），90天时分别为26%和30%（p=0.43）。在调整后的Cox回归分析中，IHT与30天（HR 0.47，95%CI 0.30至0.76）和90天（HR 0.52，95%CI 0.34至0.79）时较低的死亡风险相关。然而，IHT组30天时存活且转出ICU的天数显著更少。
在我们的研究中，重症COVID-19患者因容量限制进行的IHT与更高的死亡风险无关。转院的适宜性可能与较低的死亡率相关，尽管不能排除残余混杂因素。转院患者中有创通气的需求可能是ICU住院时间延长的原因，而非转院本身。然而，研究这个问题的困难在于，虽然患者在转院过程中可能面临风险，但他们同时也是足够稳定才能被转运的患者。
