Early indicators of intensive care unit bed requirement during the COVID-19 epidemic: A retrospective study in Ile-de-France region, France

  1. By the COVID-19 APHP-Universities-INRIA-INSERM Group

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Abstract

The aim of our retrospective study was to evaluate the earliest COVID19-related signal to anticipate requirements of intensive care unit (ICU) beds. Although the number of ICU beds is crucial during the COVID-19 epidemic, there is no recognized early indicator to anticipate it. In the Ile-de-France region, from February 20 to May 5, 2020, emergency medical service (EMS) calls and the response provided (ambulances) together the percentage of positive reverse transcriptase polymerase chain reaction (RT-PCR) tests, general practitioner (GP) and emergency department (ED) visits, and hospital admissions of COVID-19 patients were recorded daily and compared to the number of ICU patients. Correlation curve analysis was performed to determine the best correlation coefficient, depending on the number of days the indicator has been shifted. Primary endpoint was the number of ICU patients. EMS calls, percentage of positive RT-PCR tests, ambulances used, ED and GP visits of COVID-19 patients were strongly associated (R 2 ranging between 0.79 to 0.99, all P<0.001) with COVID-19 ICU patients with an anticipation delay of 23, 15, 14, 13, and 12 days respectively. Hospitalization did not anticipate ICU bed requirement. A qualitative analysis of the onset of the second wave period of the epidemic (August 1 to September 15, 2020) in the same region provided similar results. The daily number of COVID19-related telephone calls received by the EMS and corresponding dispatch ambulances, and the proportion of positive RT-PCR tests were the earliest indicators of the number of COVID19 patients requiring ICU care during the epidemic crisis, rapidly followed by ED and GP visits. This information may help health authorities to anticipate a future epidemic, including a second wave of COVID19, or decide additional social measures.

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  1. Version published to 10.1371/journal.pone.0241406
  2. ScreenIT

    SciScore for 10.1101/2020.06.02.20117499: (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

    No key resources detected.

    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:
    Several limitations of this study should be noted. First, although the sample sizes were large, our observation was limited to one region of France (with a very high population density) and one event and thus extrapolation should be interpreted with caution. Second the geographical repartition and population was not identical between some indicators and endpoints (Electronic supplement Figure S1). However, there was a very high correlation between ICU patients in the region and in APHP as the regulation of ICU bed availability was regionalized during the epidemic and based at the APHP. The GP indicator only reflects a particular activity (emergency visits at home) which is not distributed everywhere (less in rural areas) but this was the only accessible GP indicator. Because of biological test shortage, we only looked at the proportion of positive RT-PCR tests but the absolute number should probably be preferred in countries without such limitation. The presence of physicians (telemedicine) and not only emergency medical technicians (EMT) characterizes the French EMS model. Nevertheless, there is no indication suggesting that an EMT-based system using scripts may not lead to comparable results, particularly during an epidemic wave with a high prevalence of the disease. Definition of COVID-19 suspected diagnosis may have slightly varied during the study period in EMS, ED, and GP and between physicians. Admission into ICU has been modified during the study period as intensivist...

    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

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  3. Version published to 10.1101/2020.06.02.20117499v1 on medRxiv