Adam B Keene1, Andrew J Admon2,3, Samantha K Brenner4,5, Shruti Gupta6, Deepa Lazarous7, David E Leaf6, Hayley B Gershengorn1,8. 1. Albert Einstein College of Medicine, Bronx, NY, USA. 2. University of Michigan, Ann Arbor, MI, USA. 3. VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. 4. Hackensack Meridian School of Medicine at Seton Hall, Nutley, NJ, USA. 5. Heart and Vascular Hospital, Hackensack Meridian Health Hackensack University Medical Center, Hackensack, NJ, USA. 6. Brigham and Women's Hospital, Boston, MA, USA. 7. Georgetown University Hospital, Washington, DC, USA. 8. University of Miami Miller School of Medicine, Miami, FL, USA.
Abstract
OBJECTIVE: To determine whether surge conditions were associated with increased mortality. DESIGN: Multicenter cohort study. SETTING: U.S. ICUs participating in STOP-COVID. PATIENTS: Consecutive adults with COVID-19 admitted to participating ICUs between March 4 and July 1, 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The main outcome was 28-day in-hospital mortality. To assess the association between admission to an ICU during a surge period and mortality, we used two different strategies: (1) an inverse probability weighted difference-in-differences model limited to appropriately matched surge and non-surge patients and (2) a meta-regression of 50 multivariable difference-in-differences models (each based on sets of randomly matched surge- and non-surge hospitals). In the first analysis, we considered a single surge period for the cohort (March 23 - May 6). In the second, each surge hospital had its own surge period (which was compared to the same time periods in matched non-surge hospitals).Our cohort consisted of 4342 ICU patients (average age 60.8 [sd 14.8], 63.5% men) in 53 U.S. hospitals. Of these, 13 hospitals encountered surge conditions. In analysis 1, the increase in mortality seen during surge was not statistically significant (odds ratio [95% CI]: 1.30 [0.47-3.58], p = .6). In analysis 2, surge was associated with an increased odds of death (odds ratio 1.39 [95% CI, 1.34-1.43], p < .001). CONCLUSIONS: Admission to an ICU with COVID-19 in a hospital that is experiencing surge conditions may be associated with an increased odds of death. Given the high incidence of COVID-19, such increases would translate into substantial excess mortality.
OBJECTIVE: To determine whether surge conditions were associated with increased mortality. DESIGN: Multicenter cohort study. SETTING: U.S. ICUs participating in STOP-COVID. PATIENTS: Consecutive adults with COVID-19 admitted to participating ICUs between March 4 and July 1, 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The main outcome was 28-day in-hospital mortality. To assess the association between admission to an ICU during a surge period and mortality, we used two different strategies: (1) an inverse probability weighted difference-in-differences model limited to appropriately matched surge and non-surge patients and (2) a meta-regression of 50 multivariable difference-in-differences models (each based on sets of randomly matched surge- and non-surge hospitals). In the first analysis, we considered a single surge period for the cohort (March 23 - May 6). In the second, each surge hospital had its own surge period (which was compared to the same time periods in matched non-surge hospitals).Our cohort consisted of 4342 ICU patients (average age 60.8 [sd 14.8], 63.5% men) in 53 U.S. hospitals. Of these, 13 hospitals encountered surge conditions. In analysis 1, the increase in mortality seen during surge was not statistically significant (odds ratio [95% CI]: 1.30 [0.47-3.58], p = .6). In analysis 2, surge was associated with an increased odds of death (odds ratio 1.39 [95% CI, 1.34-1.43], p < .001). CONCLUSIONS: Admission to an ICU with COVID-19 in a hospital that is experiencing surge conditions may be associated with an increased odds of death. Given the high incidence of COVID-19, such increases would translate into substantial excess mortality.
Entities:
Keywords:
COVID-19; intensive care unit; mortality; occupancy; surge
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