Higher clinical acuity and 7-day hospital mortality in non-COVID-19 acute medical admissions: prospective observational study

  1. Marcus J Lyall
  2. Nazir I Lone

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Abstract

To understand the effect of COVID-19 lockdown measures on severity of illness and mortality in non-COVID-19 acute medical admissions.

Design

A prospective observational study.

Setting

3 large acute medical receiving units in NHS Lothian, Scotland.

Participants

Non-COVID-19 acute admissions (n=1682) were examined over the first 31 days after the implementation of the COVID-19 lockdown policy in the UK on 23 March 2019. Patients admitted over a matched interval in the previous 5 years were used as a comparator cohort (n=14 954).

Main outcome measures

Patient demography, biochemical markers of clinical acuity and 7-day hospital inpatient mortality.

Results

Non-COVID-19 acute medical admissions reduced by 44.9% across all three sites in comparison with the mean of the preceding 5 years (p<0.001). Patients arriving during this period were more likely to be male, of younger age and to arrive by emergency ambulance transport. Non-COVID-19 admissions during lockdown had a greater incidence of acute kidney injury, lactic acidaemia and an increased risk of hospital death within 7 days (4.2% vs 2.5%), which persisted after adjustment for confounders (OR 1.87, 95% CI 1.43 to 2.41, p<0.001).

Conclusions

These data demonstrate a significant reduction in non-COVID-19 acute medical admissions during the early weeks of lockdown. Patients admitted during this period were of higher clinical acuity with a higher incidence of early inpatient mortality.

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  1. Version published to 10.1136/emermed-2020-210030
  2. ScreenIT

    SciScore for 10.1101/2020.06.26.20098434: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Graphical outputs were performed using ggplot2 package.
    ggplot2
    suggested: (ggplot2, RRID:SCR_014601)

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The nose and throat swab test for SARS-CoV-2 is widely reported to have sensitivity limitations possible due predominance of the infection in the lungs with relatively little in the upper respiratory tract [9]. Locally we have found that 18% of patients admitted to hospital testing positive for SARS-CoV-2 were diagnosed on a subsequent follow up swab (unpublished data). Local guidelines which require repeat testing in those with a high clinical suspicion of COVID-19 may ameliorate this effect. Furthermore, patients with COVID-19 can present with atypical symptoms and signs, such as rash, seizures and gastrointestinal haemorrhage or stroke, which would not trigger testing under our local guidelines [10–12]. It may be therefore that a proportion of the increase in patient acuity and death observed is due to undiagnosed SARS-CoV-2 infection. The expansion of testing to include all hospital admissions in future may help to clarify this. To the authors’ knowledge, this is the first study examining the non-COVID-19 acute medical admissions population during the pandemic. This use of fully electronic patient records with healthcare analytics allows patient level data to be collected quickly, accurately and prospectively and rapidly linked to laboratory and national public health datasets. Furthermore, the study population benefits from complete population coverage of all residents within a single administrative health region who were admitted. There are limitations to this study. Fo...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).

    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

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  3. Version published to 10.1101/2020.06.26.20098434v1 on medRxiv