COVID-19 Management in a UK NHS Foundation Trust with a High Consequence Infectious Diseases Centre: A Retrospective Analysis

  1. Kenneth Baker
  2. Aidan Hanrath
  3. Ina Schim van der Loeff
  4. Su Tee
  5. Richard Capstick
  6. Gabriella Marchitelli
  7. Ang Li
  8. Andrew Barr
  9. Alsafi Eid
  10. Sajeel Ahmed
  11. Dalvir Bajwa
  12. Omer Mohammed
  13. Neil Alderson
  14. Clare Lendrem
  15. Dennis Lendrem
  16. COVID-19 Control Group
  17. COVID-19 Clinical Group
  18. Lucia Pareja-Cebrian
  19. Andrew Welch
  20. Joanne Field
  21. Brendan Payne
  22. Yusri Taha
  23. David Price
  24. Christopher Gibbins
  25. Matthias Schmid
  26. Ewan Hunter
  27. Christopher Duncan

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Abstract

Recent large national and international cohorts describe the baseline characteristics and outcome of hospitalised patients with COVID-19, however there is limited granularity to these reports. We aimed to provide a detailed description of a UK COVID-19 cohort, focusing on management and outcome. We performed a retrospective single-centre analysis of clinical management and 28-day outcomes of consecutive adult inpatients with SARS-CoV-2 PCR-confirmed COVID-19 from 31 January to 16 April 2020 inclusive. In total, 316 cases were identified. Most patients were elderly (median age 75) with multiple comorbidities. One quarter were admitted from residential or nursing care. Mortality was 84 out of 316 (26.6%). Most deaths occurred in patients in whom a ceiling of inpatient treatment had been determined and for whom end of life care and specialist palliative care input was provided where appropriate. No deaths occurred in patients aged under 56 years. Decisions to initiate respiratory support were individualised after consideration of patient wishes, premorbid frailty and comorbidities. In total, 59 (18%) patients were admitted to intensive care, of which 31 (10% overall cohort) required intubation. Multiple logistic regression identified associations between death and age, frailty, and disease severity, with age as the most significant factor (odds ratio 1.07 [95% CI 1.03–1.10] per year increase, p < 0.001). These findings provide important clinical context to outcome data. Mortality was associated with increasing age. Most deaths were anticipated and occurred in patients with advance decisions on ceilings of treatment.

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  1. Version published to 10.3390/medsci9010006
  2. ScreenIT

    SciScore for 10.1101/2020.05.14.20100834: (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 variableThe significance of departure of observed male sex proportion from an expected value of 0.5 was assessed using the one sample z-test.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Electronic health records were retrospectively reviewed by a team of medical doctors with the aid of a standardised version-controlled data collection template (Excel, Microsoft Corporation) with internal data validation restrictions.
    Excel
    suggested: None
    Analyses were performed in R (version 3.6.0, R Core Team) and SAS JMP Pro(version 13.2.1, SAS Institute, Cary NC).
    SAS JMP Pro(version
    suggested: None
    SAS Institute
    suggested: (Statistical Analysis System, RRID:SCR_008567)

    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 study has several limitations. Data were retrospectively collected at a single NHS Trust, and may therefore not reflect COVID-19 transmission patterns in other parts of the UK nor necessarily reflect inpatient management across the wider NHS. Whilst our cohort size is similar to published analyses,3,17 the number of patients is relatively low. In addition, the modelling was based on a subset of patients for which adequate data was available and excluded those with nosocomial infection. Strengths of this analysis are the extended length of follow up, which is longer than most published cohorts, the large proportion of cases with definite clinical endpoints, and robust clinical informatics mechanisms to capture deaths in the community occurring after discharge. This report is the first to provide a detailed description of the inpatient management of COVID-19 at the individual patient level, complementing and enriching existing literature. These results will be broadly informative to clinicians, policy makers and healthcare providers.

    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.

  3. Version published to 10.1101/2020.05.14.20100834v1 on medRxiv