Patient characteristics, clinical care, resource use, and outcomes associated with hospitalization for COVID-19 in the Toronto area

  1. Amol A. Verma
  2. Tejasvi Hora
  3. Hae Young Jung
  4. Michael Fralick
  5. Sarah L. Malecki
  6. Lauren Lapointe-Shaw
  7. Adina Weinerman
  8. Terence Tang
  9. Janice L. Kwan
  10. Jessica J. Liu
  11. Shail Rawal
  12. Timothy C.Y. Chan
  13. Angela M. Cheung
  14. Laura C. Rosella
  15. Marzyeh Ghassemi
  16. Margaret Herridge
  17. Muhammad Mamdani
  18. Fahad Razak

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

Background

Patient characteristics, clinical care, resource use, and outcomes associated with hospitalization for coronavirus disease (COVID-19) in Canada are not well described.

Methods

We described all adult discharges from inpatient medical services and medical-surgical intensive care units (ICU) between November 1, 2019 and June 30, 2020 at 7 hospitals in Toronto and Mississauga, Ontario. We compared patients hospitalized with COVID-19, influenza and all other conditions using multivariable regression models controlling for patient age, sex, comorbidity, and residence in long-term-care.

Results

There were 43,462 discharges in the study period, including 1,027 (3.0%) with COVID-19 and 783 (2.3%) with influenza. Patients with COVID-19 had similar age to patients with influenza and other conditions (median age 65 years vs. 68 years and 68 years, respectively, SD<0.1). Patients with COVID-19 were more likely to be male (59.1%) and 11.7% were long-term care residents. Patients younger than 50 years accounted for 21.2% of all admissions for COVID-19 and 24.0% of ICU admissions. Compared to influenza, patients with COVID-19 had significantly greater mortality (unadjusted 19.9% vs 6.1%, aRR: 3.47, 95%CI: 2.57, 4.67), ICU use (unadjusted 26.4% vs 18.0%, aRR 1.52, 95%CI: 1.27, 1.83) and hospital length-of-stay (unadjusted median 8.7 days vs 4.8 days, aRR: 1.40, 95%CI: 1.20, 1.64), and not significantly different 30-day readmission (unadjusted 8.6% vs 8.2%, aRR: 1.01, 95%CI: 0.72, 1.42).

Interpretation

Adults hospitalized with COVID-19 during the first wave of the pandemic used substantial hospital resources and suffered high mortality. COVID-19 was associated with significantly greater mortality, ICU use, and hospital length-of-stay than influenza.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2020.12.15.20248199: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: 19 Research ethics board approval was obtained from all participating organizations.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Design and Setting: This retrospective cohort study was conducted at 7 large hospitals (5 academic and 2 community-based teaching hospitals) in Toronto and Mississauga, Ontario, participating in GEMINI, a hospital research collaborative.
    GEMINI
    suggested: (GEMINI, RRID:SCR_014819)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has several limitations. First, we included 7 large academic hospitals. COVID-19 patients were transferred to these hospitals for critical care, which may lead us to overestimate the severity of COVID-19. To address this concern, we compared COVID-19 to influenza and other conditions, for which patients could also have been transferred. We also replicated our analyses in patients admitted through the ED to exclude inter-facility transfers. In this analysis, 20% of COVID-19 patients died in hospital, 18% required ICU, and the mortality rate compared to influenza was even greater (aRR 3.96). We believe our results are generalizable as mortality in our cohort was consistent with large studies from the United States1 and United Kingdom4 and we included approximately 25% of all COVID-19 hospitalizations in Ontario during the study period. Second, although COVID-19 disproportionately affects racial and ethnic minority communities43, data regarding patient race, ethnicity, language, or socioeconomic status is not collected systematically in Ontario hospitals and could not be reported. Third, we were unable to collect information about clinical history or symptoms, as this was not captured systematically in administrative or electronic medical record data. Fourth, we report 30-day readmission to a medical service or medical-surgical ICU at any participating hospital. Although this likely underestimates the total readmission rate, 82% of readmissions occur to the original ho...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.12.15.20248199v1 on medRxiv