Ten months of temporal variation in the clinical journey of hospitalised patients with COVID-19: an observational cohort
Abstract
Background: There is potentially considerable variation in the nature and duration of the care provided to hospitalised patients during an infectious disease epidemic or pandemic. Improvements in care and clinician confidence may shorten the time spent as an inpatient, or the need for admission to an intensive care unit (ICU) or high density unit (HDU). On the other hand, limited resources at times of high demand may lead to rationing. Nevertheless, these variables may be used as static proxies for disease severity, as outcome measures for trials, and to inform planning and logistics.
Methods: We investigate these time trends in an extremely large international cohort of 142,540 patients hospitalised with COVID-19. Investigated are: time from symptom onset to hospital admission, probability of ICU/HDU admission, time from hospital admission to ICU/HDU admission, hospital case fatality ratio (hCFR) and total length of hospital stay.
Results: Time from onset to admission showed a rapid decline during the first months of the pandemic followed by peaks during August/September and December 2020. ICU/HDU admission was more frequent from June to August. The hCFR was lowest from June to August. Raw numbers for overall hospital stay showed little variation, but there is clear decline in time to discharge for ICU/HDU survivors.
Conclusions: Our results establish that variables of these kinds have limitations when used as outcome measures in a rapidly-evolving situation.
Funding: This work was supported by the UK Foreign, Commonwealth and Development Office and Wellcome [215091/Z/18/Z] and the Bill and Melinda Gates Foundation [OPP1209135]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Data availability
The data that underpin this analysis are highly detailed clinical data on individuals hosptialised with COVID-19. Due to the sensitive nature of these data and the associated privacy concerns, they are available via a governed data access mechanism following review of a data access committee. Data can be requested via the IDDO COVID-19 Data Sharing Platform (www.iddo.org/covid-19). The Data Access Application, Terms of Access and details of the Data Access Committee are available on the website. Briefly, the requirements for access are a request from a qualified researcher working with a legal entity who have a health and/or research remit; a scientifically valid reason for data access which adheres to appropriate ethical principles. The full terms are at https://www.iddo.org/document/covid-19-data-access-guidelinesA small subset of sites who contributed data to this analysis have not agreed to pooled data sharing as above. In the case of requiring access to these data, please contact the corresponding author in the first instance who will look to facilitate access.We have provided the R code used to process data and run the regression analysis at https://github.com/ISARICDataPlatform/InpatientJourneyDataProcessing. Source data for all figures has also been provided.
Article and author information
Author details
Funding
UK FCDO and Wellcome Trust (215091/Z/18/Z)
- Joaquín Baruch
- Jake Dunning
- Martina Escher
- Jia Wei
- Peter W Horby
- Piero Luigi Olliaro
Bill and Melinda Gates Foundation (OPP1209135)
- Joaquín Baruch
- Jake Dunning
- Martina Escher
- Jia Wei
- Peter W Horby
- Piero Luigi Olliaro
University of Oxford's COVID-19 Research Response Fund (0009146)
- Laura Merson
The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.
Ethics
Human subjects: The study was approved by the World Health Organization Ethics Review Committee (RPC571 and RPC572). Local ethics approval was obtained for each participating country and site according to local requirements. All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.
Copyright
© 2021, Hall et al.
This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.
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