1. Ten months of temporal variation in the clinical journey of hospitalised patients with COVID-19
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Charlotte Summers, Hanna Jung, Hikombo HITOTO, Giulio Giovanni Cavalli, Mark Pritchard, Susanne Gjeruldsen Dudman, Cornelius Rau, Yusing Gu, Obada Yousif, Benjamin Lefèvre, Jamel Ortoleva, Carlos Lumbreras, Yvelynne Kelly, Matthew Hall, Andreas Lind, Antonio Loforte, Aquiles Rodrigo Henríquez-Trujillo, Rafael Freitas de Oliveira Franca, Manuel Etienne, Daniel Alejandro Pérez Muñoz, Moirangthem Bikram singh, Sebastiano Maria Colombo, Agnieszka Ołdakowska, Malcolm Gracie Semple, Anders Benjamin Kildal, Tom Fletcher, Kalynn Kennon, Sarah Cormican, Ali AIT HSSAIN, Bernard CHOLLEY, Gianluigi Li Bassi, Hernando Torres-Zevallos, Luís Bento, Leanne Hays, Lara Absil, Roberto Roncon Albuquerque Jr, Maria Toki, Oksana Kruglova, Louise Sigfrid, Colin McCloskey, Eder Caceres, Jaques Sztajnbok, Sebastien Preau, Federico D'AMICO, Guillaume Louis, Nina Buchtele, Manuel Rosa-calatrava, Dorothy Breen, Christopher Green, Denise Battaglini, Jolanta Popielska, Helena Barrasa, Olivier Terrier, Jacky Suen, Hoi Ping Shum, Guillaume Martin-Blondel, Stella Rousset, Eric D'Ortenzio, Miguel Pedrera-Jiménez, Willem Dieperink, Ioannis Trontzas, Barbara Wanjiru Citarella, Shona Moore, Sofia Tejada, Abigail Beane, John Kenneth Baillie, Simone Piva, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), Medical Research Council (MRC), Group, ISARIC Clinical Characterisation, Hall, Matthew D [0000-0002-2671-3864], Merson, Laura [0000-0002-4168-1960], Apollo - University of Cambridge Repository, Hall, M., Baruch, J., Carson, G., Citarella, B. W., Dagens, A., Dankwa, E. A., Donnelly, C. A., Dunning, J., Escher, M., Kartsonaki, C., Merson, L., Pritchard, M. G., Wei, J., Horby, P., Rojek, A., Olliaro, P. L., and Durante-Mangoni, E
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Male ,Outcome Assessment ,global health ,0601 Biochemistry and Cell Biology ,law.invention ,law ,Case fatality rate ,Pandemic ,Epidemiology ,Outcome Assessment, Health Care ,80 and over ,ISARIC Clinical Characterisation Group ,Biology (General) ,Outcome Assessment, Health Care/statistics & numerical data ,Child ,Aged, 80 and over ,General Neuroscience ,COVID-19 ,ICU ,SARS-CoV-2 ,epidemiology ,hospitalisation ,human ,medicine ,viruses ,Adolescent ,Adult ,Aged ,Child, Preschool ,Female ,Hospitalization ,Humans ,Infant ,Intensive Care Units ,Length of Stay ,Middle Aged ,Retrospective Studies ,Young Adult ,General Medicine ,Intensive care unit ,Length of Stay/statistics & numerical data ,Cohort ,Intensive Care Units/statistics & numerical data ,Medicine ,Global health ,Human ,Viruses ,Research Article ,COVID-19/therapy ,medicine.medical_specialty ,Health Care/statistics & numerical data ,Coronavirus disease 2019 (COVID-19) ,QH301-705.5 ,Science ,General Biochemistry, Genetics and Molecular Biology ,Disease severity ,Preschool ,Hospitalization/statistics & numerical data ,General Immunology and Microbiology ,business.industry ,SARS-CoV-2/pathogenicity ,Health Care ,Epidemiology and Global Health ,Emergency medicine ,Observational study ,business - 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 dependency 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 & Melinda Gates Foundation [OPP1209135]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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- 2021