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Clinical Mortality in a Large COVID-19 Cohort: Observational Study.

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  • معلومة اضافية
    • المصدر:
      Publisher: JMIR Publications Country of Publication: Canada NLM ID: 100959882 Publication Model: Electronic Cited Medium: Internet ISSN: 1438-8871 (Electronic) Linking ISSN: 14388871 NLM ISO Abbreviation: J Med Internet Res Subsets: MEDLINE
    • بيانات النشر:
      Publication: <2011- > : Toronto : JMIR Publications
      Original Publication: [Pittsburgh, PA? : s.n., 1999-
    • الموضوع:
      Demography*; Coronavirus Infections/*mortality ; Pneumonia, Viral/*mortality; Adult ; Aged ; Aged, 80 and over ; Betacoronavirus ; COVID-19 ; Cohort Studies ; Female ; Heart Arrest/epidemiology ; Heart Arrest/mortality ; Hospital Mortality ; Hospital Rapid Response Team ; Hospitalization/statistics & numerical data ; Humans ; Inpatients/statistics & numerical data ; Intensive Care Units ; Male ; Medical Records ; Middle Aged ; New York/epidemiology ; Oxygen/metabolism ; Pandemics ; SARS-CoV-2 ; Young Adult
    • نبذة مختصرة :
      Background: Northwell Health, an integrated health system in New York, has treated more than 15,000 inpatients with COVID-19 at the US epicenter of the SARS-CoV-2 pandemic.
      Objective: We describe the demographic characteristics of patients who died of COVID-19, observation of frequent rapid response team/cardiac arrest (RRT/CA) calls for non-intensive care unit (ICU) patients, and factors that contributed to RRT/CA calls.
      Methods: A team of registered nurses reviewed the medical records of inpatients who tested positive for SARS-CoV-2 via polymerase chain reaction before or on admission and who died between March 13 (first Northwell Health inpatient expiration) and April 30, 2020, at 15 Northwell Health hospitals. The findings for these patients were abstracted into a database and statistically analyzed.
      Results: Of 2634 patients who died of COVID-19, 1478 (56.1%) had oxygen saturation levels ≥90% on presentation and required no respiratory support. At least one RRT/CA was called on 1112/2634 patients (42.2%) at a non-ICU level of care. Before the RRT/CA call, the most recent oxygen saturation levels for 852/1112 (76.6%) of these non-ICU patients were at least 90%. At the time the RRT/CA was called, 479/1112 patients (43.1%) had an oxygen saturation of <80%.
      Conclusions: This study represents one of the largest reviewed cohorts of mortality that also captures data in nonstructured fields. Approximately 50% of deaths occurred at a non-ICU level of care despite admission to the appropriate care setting with normal staffing. The data imply a sudden, unexpected deterioration in respiratory status requiring RRT/CA in a large number of non-ICU patients. Patients admitted at a non-ICU level of care suffered rapid clinical deterioration, often with a sudden decrease in oxygen saturation. These patients could benefit from additional monitoring (eg, continuous central oxygenation saturation), although this approach warrants further study.
      (©Mark Jarrett, Susanne Schultz, Julie Lyall, Jason Wang, Lori Stier, Marcella De Geronimo, Karen Nelson. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 25.09.2020.)
    • Comments:
      Update of: medRxiv. 2020 Aug 06:2020.08.05.20168146. doi: 10.1101/2020.08.05.20168146.. (PMID: 32793915)
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    • Grant Information:
      R01 LM012836 United States LM NLM NIH HHS; R24 AG064191 United States AG NIA NIH HHS
    • Contributed Indexing:
      Keywords: COVID-19; ICU; cohort; hypoxemia; intensive care unit; mortality; observational; respiratory failure; review
    • الرقم المعرف:
      S88TT14065 (Oxygen)
    • الموضوع:
      Date Created: 20200915 Date Completed: 20201005 Latest Revision: 20250310
    • الموضوع:
      20250310
    • الرقم المعرف:
      PMC7537718
    • الرقم المعرف:
      10.2196/23565
    • الرقم المعرف:
      32930099