tetano
Editor, Senior Moderator
Wellcome Open Res
. 2021 Nov 10;6:159.
doi: 10.12688/wellcomeopenres.16953.2. eCollection 2021.
Impact of COVID-19 on non-COVID intensive care unit service utilization, case mix and outcomes: A registry-based analysis from India
Indian Registry of IntenSive care (IRIS); Neill Kj Adhikari[SUP] 1 [/SUP], Abi Beane[SUP] 2 [/SUP], Dedeepiya Devaprasad[SUP] 3 [/SUP], Robert Fowler[SUP] 1 [/SUP], Rashan Haniffa[SUP] 2 [/SUP], Augustian James[SUP] 4 [/SUP], Devachandran Jayakumar[SUP] 3 [/SUP], Chamira Kodippily[SUP] 5 [/SUP], Rohit Aravindakshan Kooloth[SUP] 3 [/SUP], Rakesh Laxmappa[SUP] 6 [/SUP], Kishore Mangal[SUP] 7 [/SUP], Ashwin Mani[SUP] 8 [/SUP], Meghena Mathew[SUP] 8 [/SUP], Vrindha Pari[SUP] 9 [/SUP], Sristi Patodia[SUP] 10 [/SUP], Rajyabardhan Pattnaik[SUP] 11 [/SUP], Dilanthi Priyadarshini[SUP] 5 [/SUP], Mathew Pulicken[SUP] 12 [/SUP], Ebenezer Rabindrarajan[SUP] 3 [/SUP], Pratheema Ramachandran[SUP] 3 [/SUP], Kavita Ramesh[SUP] 13 [/SUP], Usha Rani[SUP] 3 [/SUP], Ananth Ramaiyan[SUP] 9 [/SUP], Nagarajan Ramakrishnan[SUP] 4 [/SUP], Lakshmi Ranganathan[SUP] 4 [/SUP], Aasiyah Rashan[SUP] 5 [/SUP], Raymond Dominic Savio[SUP] 10 [/SUP], Jaganathan Selva[SUP] 14 [/SUP], Bharath Kumar Tirupakuzhi Vijayaraghavan[SUP] 4 [/SUP], Swagata Tripathy[SUP] 15 [/SUP], Ishara Udayanga[SUP] 5 [/SUP], Ramesh Venkataraman[SUP] 4 [/SUP]
Affiliations
Abstract
Background: Coronavirus disease 2019 (COVID-19) has been responsible for over 3.4 million deaths globally and over 25 million cases in India. As part of the response, India imposed a nation-wide lockdown and prioritized COVID-19 care in hospitals and intensive care units (ICUs). Leveraging data from the Indian Registry of IntenSive care, we sought to understand the impact of the COVID-19 pandemic on critical care service utilization, case-mix, and clinical outcomes in non-COVID ICUs. Methods: We included all consecutive patients admitted between 1 [SUP]st[/SUP] October 2019 and 27 [SUP]th[/SUP] September 2020. Data were extracted from the registry database and included patients admitted to the non-COVID or general ICUs at each of the sites. Outcomes included measures of resource-availability, utilisation, case-mix, acuity, and demand for ICU beds. We used a Mann-Whitney test to compare the pre-pandemic period (October 2019 - February 2020) to the pandemic period (March-September 2020). In addition, we also compared the period of intense lockdown (March-May 31 [SUP]st[/SUP] 2020) with the pre-pandemic period. Results: There were 3424 patient encounters in the pre-pandemic period and 3524 encounters in the pandemic period. Comparing these periods, weekly admissions declined (median [Q1 Q3] 160 [145,168] to 113 [98.5,134]; p<0.001); unit turnover declined (median [Q1 Q3] 12.1 [11.32,13] to 8.58 [7.24,10], p<0.001), and APACHE II score increased (median [Q1 Q3] 19 [19,20] to 21 [20,22] ; p<0.001). Unadjusted ICU mortality increased (9.3% to 11.7%, p=0.015) and the length of ICU stay was similar (median [Q1 Q3] 2.11 [2, 2] vs. 2.24 [2, 3] days; p=0.151). Conclusion: Our registry-based analysis of the impact of COVID-19 on non-COVID critical care demonstrates significant disruptions to healthcare utilization during the pandemic and an increase in the severity of illness.
Keywords: COVID-19; critical care; registries; severity of illness.
. 2021 Nov 10;6:159.
doi: 10.12688/wellcomeopenres.16953.2. eCollection 2021.
Impact of COVID-19 on non-COVID intensive care unit service utilization, case mix and outcomes: A registry-based analysis from India
Indian Registry of IntenSive care (IRIS); Neill Kj Adhikari[SUP] 1 [/SUP], Abi Beane[SUP] 2 [/SUP], Dedeepiya Devaprasad[SUP] 3 [/SUP], Robert Fowler[SUP] 1 [/SUP], Rashan Haniffa[SUP] 2 [/SUP], Augustian James[SUP] 4 [/SUP], Devachandran Jayakumar[SUP] 3 [/SUP], Chamira Kodippily[SUP] 5 [/SUP], Rohit Aravindakshan Kooloth[SUP] 3 [/SUP], Rakesh Laxmappa[SUP] 6 [/SUP], Kishore Mangal[SUP] 7 [/SUP], Ashwin Mani[SUP] 8 [/SUP], Meghena Mathew[SUP] 8 [/SUP], Vrindha Pari[SUP] 9 [/SUP], Sristi Patodia[SUP] 10 [/SUP], Rajyabardhan Pattnaik[SUP] 11 [/SUP], Dilanthi Priyadarshini[SUP] 5 [/SUP], Mathew Pulicken[SUP] 12 [/SUP], Ebenezer Rabindrarajan[SUP] 3 [/SUP], Pratheema Ramachandran[SUP] 3 [/SUP], Kavita Ramesh[SUP] 13 [/SUP], Usha Rani[SUP] 3 [/SUP], Ananth Ramaiyan[SUP] 9 [/SUP], Nagarajan Ramakrishnan[SUP] 4 [/SUP], Lakshmi Ranganathan[SUP] 4 [/SUP], Aasiyah Rashan[SUP] 5 [/SUP], Raymond Dominic Savio[SUP] 10 [/SUP], Jaganathan Selva[SUP] 14 [/SUP], Bharath Kumar Tirupakuzhi Vijayaraghavan[SUP] 4 [/SUP], Swagata Tripathy[SUP] 15 [/SUP], Ishara Udayanga[SUP] 5 [/SUP], Ramesh Venkataraman[SUP] 4 [/SUP]
Affiliations
- PMID: 34957335
- PMCID: PMC8666986
- DOI: 10.12688/wellcomeopenres.16953.2
Abstract
Background: Coronavirus disease 2019 (COVID-19) has been responsible for over 3.4 million deaths globally and over 25 million cases in India. As part of the response, India imposed a nation-wide lockdown and prioritized COVID-19 care in hospitals and intensive care units (ICUs). Leveraging data from the Indian Registry of IntenSive care, we sought to understand the impact of the COVID-19 pandemic on critical care service utilization, case-mix, and clinical outcomes in non-COVID ICUs. Methods: We included all consecutive patients admitted between 1 [SUP]st[/SUP] October 2019 and 27 [SUP]th[/SUP] September 2020. Data were extracted from the registry database and included patients admitted to the non-COVID or general ICUs at each of the sites. Outcomes included measures of resource-availability, utilisation, case-mix, acuity, and demand for ICU beds. We used a Mann-Whitney test to compare the pre-pandemic period (October 2019 - February 2020) to the pandemic period (March-September 2020). In addition, we also compared the period of intense lockdown (March-May 31 [SUP]st[/SUP] 2020) with the pre-pandemic period. Results: There were 3424 patient encounters in the pre-pandemic period and 3524 encounters in the pandemic period. Comparing these periods, weekly admissions declined (median [Q1 Q3] 160 [145,168] to 113 [98.5,134]; p<0.001); unit turnover declined (median [Q1 Q3] 12.1 [11.32,13] to 8.58 [7.24,10], p<0.001), and APACHE II score increased (median [Q1 Q3] 19 [19,20] to 21 [20,22] ; p<0.001). Unadjusted ICU mortality increased (9.3% to 11.7%, p=0.015) and the length of ICU stay was similar (median [Q1 Q3] 2.11 [2, 2] vs. 2.24 [2, 3] days; p=0.151). Conclusion: Our registry-based analysis of the impact of COVID-19 on non-COVID critical care demonstrates significant disruptions to healthcare utilization during the pandemic and an increase in the severity of illness.
Keywords: COVID-19; critical care; registries; severity of illness.