Aeromedical retrieval diagnostic trends during a period of Coronavirus 2019 lockdown

  1. Fergus W. Gardiner
  2. Marianne Gillam
  3. Leonid Churilov
  4. Pritish Sharma
  5. Mardi Steere
  6. Michelle Hannan
  7. Andrew Hooper
  8. Frank Quinlan

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Abstract

Background

Little is known on the trends of aeromedical retrieval (AR) during social isolation.

Aim

To compare the pre, lockdown, and post‐lockdown AR patient characteristics during a period of Coronavirus 2019 (COVID‐19) social isolation.

Methods

An observational study with retrospective data collection, consisting of AR between 26 January and 23 June 2020.

Results

There were 16 981 AR consisting of 1983 (11.7%) primary evacuations and 14 998 (88.3%) inter‐hospital transfers, with a population median age of 52 years (interquartile range 29.0–69.0), with 49.0% ( n = 8283) of the cohort being male and 38.0% ( n = 6399) being female. There were six confirmed and 230 suspected cases of COVID‐19, with the majority of cases ( n = 134; 58.3%) in the social isolation period. As compared to pre‐restriction, the odds of retrieval for the restriction and post‐restriction period differed across time between the major diagnostic groups. This included, an increase in cardiovascular retrieval for both restriction and post‐restriction periods (odds ratio (OR) 1.12, 95% confidence interval (CI) 1.02–1.24 and OR 1.18 95%, CI 1.08–1.30 respectively), increases in neoplasm in the post restriction period (OR 1.31, 95% CI 1.04–1.64) and increases for congenital conditions in the restriction period (OR 2.56, 95% CI 1.39–4.71). Cardiovascular and congenital conditions had increased rates of priority 1 patients in the restriction and post restriction periods. There was a decrease in endocrine and metabolic disease retrievals in the restriction period (OR 0.72, 95% CI 0.53–0.98). There were lower odds during the post‐restriction period for retrievals of the respiratory system (OR 0.78, 95% CI 0.67–0.93), and disease of the skin (OR 0.78, 95% CI 0.6–1.0). Distribution between the 2019 and 2020 time periods differed ( P < 0.05), with the lockdown period resulting in a significant reduction in activity.

Conclusion

The lockdown period resulted in increased AR rates of circulatory and congenital conditions.

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    SciScore for 10.1101/2020.08.16.20176230: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementConsent: As this project involved routinely collected data, specific patient consent forms were not required.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analyses were performed using Stata 15IC statistical software (StataCorp, College Station, TX, USA) with graphs implemented in the statistical software package R version 3.5.1.
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    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:
    This may reflect patients delaying early invention due to social isolation measures and limitations in accessing primary healthcare services.17,18 This appeared to be the case, as there were more circulatory system cases during the post-lockdown period. Cardiovascular disease, older adults, those with respiratory disease, and diabetes are at the highest risk of complications from COVID-19 infection. While many of our patients would not be considered old, with a median age of 52 years old, many of the retrievals were for endocrine disease, and specifically uncontrolled diabetes. Many of these patients come from rural and remote areas, which also have high rates of metabolic syndrome.18 Uncontrolled diabetes, or chronic hyperglycaemia, negatively affects the immune system increasing morbidity and mortality due to increased infection risk and organic complications.19 For example, those with Influenza A (H1N1) and diabetes, have triple the risk of hospitalization and quadruple the risk of intensive care unit (ICU) admission once hospitalized.20 It is likely that COVID-19 infection coupled with diabetes would have similar rates,20 as the mortality rates in China indicate that 42.3% of their COVID-19 deaths had diabetes.21 A striking finding was that there were significantly more paediatric patients retrieved for congenital malformations of the circulatory system during the lockdown period, most requiring a IHT from a rural area to a large metropolitan hospital mainly for cardiac s...

    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.

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  2. Version published to 10.1111/imj.15091
  3. Version published to 10.1101/2020.08.16.20176230v2 on medRxiv
  4. Version published to 10.1101/2020.08.16.20176230v1 on medRxiv