Preprint Article Version 2 Preserved in Portico This version is not peer-reviewed

Trends in Intensive Care for Patients with COVID-19 in England, Wales and Northern Ireland

Version 1 : Received: 10 August 2020 / Approved: 11 August 2020 / Online: 11 August 2020 (13:45:43 CEST)
Version 2 : Received: 8 September 2020 / Approved: 9 September 2020 / Online: 9 September 2020 (09:28:49 CEST)

How to cite: Doidge, J.C.; Mouncey, P.R.; Thomas, K.; Gould, D.W.; Ferrando-Vivas, P.; Shankar-Hari, M.; Harrison, D.A.; Rowan, K.M. Trends in Intensive Care for Patients with COVID-19 in England, Wales and Northern Ireland. Preprints 2020, 2020080267 (doi: 10.20944/preprints202008.0267.v2). Doidge, J.C.; Mouncey, P.R.; Thomas, K.; Gould, D.W.; Ferrando-Vivas, P.; Shankar-Hari, M.; Harrison, D.A.; Rowan, K.M. Trends in Intensive Care for Patients with COVID-19 in England, Wales and Northern Ireland. Preprints 2020, 2020080267 (doi: 10.20944/preprints202008.0267.v2).

Abstract

Rationale: Examining trends in patient characteristics, processes of care and outcomes, across an epidemic, provides important opportunities for learning. Objectives: To report and explore changes in admission rates, patient characteristics, processes of care and outcomes for all patients with COVID-19 admitted to intensive care units (ICUs) in England, Wales and Northern Ireland. Methods: Population cohort of 10,287 patients with COVID-19 in the Case Mix Programme national clinical audit from 1 February to 2 July, 2020. Analyses were stratified by time period (pre-peak, peak, post-peak) and geographical region. Multivariable logistic regression was used to estimate differences in 28-day mortality, adjusting for patient characteristics over time. Main results: Admissions to ICU peaked simultaneously across regions on 1 April, with ongoing admissions peaking ten days later. Compared with pre- and post-peak periods, patients admitted during the peak were slightly younger but had greater respiratory and renal dysfunction. Use of invasive ventilation and renal replacement reduced over time. Twenty-eight-day mortality reduced from 43.5% (95% CI 41.6% to 45.5%) pre-peak to 34.3% (95% CI 32.3% to 36.2%) post-peak; a difference of −8.8% (95% CI: −5.2%, −12.3%) after adjusting for patient characteristics. London experienced the highest admission rate and had higher mortality during the peak period but a greater reduction in post-peak mortality. Conclusion: This study highlights changes in patient characteristics, processes of care and outcomes, during the UK COVID-19 epidemic. After adjusting for the changes in patient characteristics and first 24-hour physiology, there was substantial improvement in 28-day mortality over the course of the epidemic.

Subject Areas

COVID-19; intensive care; trends; United Kingdom; mortality; mechanical ventilation

Comments (1)

Comment 1
Received: 9 September 2020
Commenter: David Harrison
Commenter's Conflict of Interests: Author
Comment: Correction of typographical errors and refinement of text to Results and Discussion.
+ Respond to this comment

We encourage comments and feedback from a broad range of readers. See criteria for comments and our diversity statement.

Leave a public comment
Send a private comment to the author(s)
Views 0
Downloads 0
Comments 1
Metrics 0


×
Alerts
Notify me about updates to this article or when a peer-reviewed version is published.
We use cookies on our website to ensure you get the best experience.
Read more about our cookies here.