Comparison of Outcomes and Process of Care for Patients Treated at Hospitals Dedicated for COVID-19 Care vs Other Hospitals

Bergman, Zachary; Usher, Michael; Olson, Andrew; Chipman, Jeffrey G.; Brunsvold, Melissa E.; Beilman, Greg J.; Tignanelli, Christopher J.; Lusczek, Elizabeth R.

doi:10.1001/jamanetworkopen.2022.0873

Cited by 9 publications

(10 citation statements)

References 25 publications

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“…This finding is important because evidence both before and during the COVID-19 era showed that, among patients with ARDS, oxygenation on the third day after intubation may be more strongly associated with mortality than oxygenation on the day of intubation . Also, the occurrence of bacteremia among survivors was 57.1% (8 of 14) in the full vaccination group vs 73.9% (65 of 88) in the control group, and, although statistically insignificant, this difference in occurrence might be associated with different mortality rates between groups …”

Section: Discussionmentioning

confidence: 86%

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Association Between Vaccination Status and Mortality Among Intubated Patients With COVID-19–Related Acute Respiratory Distress Syndrome

et al. 2022

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ImportanceAlthough vaccination substantially reduces the risk of severe COVID-19, it is yet unknown whether vaccinated patients who develop COVID-19 and require invasive mechanical ventilation have lower mortality than controls.ObjectiveTo examine the association between COVID-19 vaccination status and mortality among critically ill patients who require invasive mechanical ventilation owing to acute respiratory distress syndrome (ARDS) related to COVID-19.Design, Setting, and ParticipantsThis multicenter cohort study was performed between June 7, 2021, and February 1, 2022, among 265 consecutive adult patients with COVID-19 in academic intensive care units who underwent invasive mechanical ventilation owing to ARDS.ExposuresPatients in the full vaccination group had completed the primary COVID-19 vaccination series more than 14 days but less than 5 months prior to intubation. This time threshold was chosen because guidelines from the US Centers for Disease Control and Prevention recommend a booster dose beyond that time. The remaining patients (ie, those who were unvaccinated, partially vaccinated, or fully vaccinated &lt;14 days or &gt;5 months before intubation) comprised the control group.Main Outcomes and MeasuresThe primary outcome was time from intubation to all-cause intensive care unit mortality. A Cox proportional hazards regression model including vaccination status, age, comorbid conditions, and baseline Sequential Organ Failure Assessment score on the day of intubation was used.ResultsA total of 265 intubated patients (170 men [64.2%]; median age, 66.0 years [IQR, 58.0-76.0 years]; 26 [9.8%] in the full vaccination group) were included in the study. A total of 20 patients (76.9%) in the full vaccination group received the BNT162b2 vaccine, and the remaining 6 (23.1%) received the ChAdOx1 nCoV-19 vaccine. Patients in the full vaccination group were older (median age, 72.5 years [IQR, 62.8-80.0 years] vs 66.0 years [IQR, 57.0-75.0 years]) and more likely to have comorbid conditions (24 of 26 [92.3%] vs 160 of 239 [66.9%]), including malignant neoplasm (6 of 26 [23.1%] vs 18 of 239 [7.5%]), than those in the control group. Full vaccination status was significantly associated with lower mortality compared with controls (16 of 26 patients [61.5%] died in the full vaccination group vs 163 of 239 [68.2%] in the control group; hazard ratio, 0.55 [95% CI, 0.32-0.94]; P = .03).Conclusions and RelevanceIn this cohort study, full vaccination status was associated with lower mortality compared with controls, which suggests that vaccination might be beneficial even among patients who were intubated owing to COVID-19–related ARDS. These results may inform discussions with families about prognosis.

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Section: Discussionmentioning

confidence: 86%

“… 16 , 17 Also, the occurrence of bacteremia among survivors was 57.1% (8 of 14) in the full vaccination group vs 73.9% (65 of 88) in the control group, and, although statistically insignificant, this difference in occurrence might be associated with different mortality rates between groups. 18 …”

Section: Discussionmentioning

confidence: 99%

Association Between Vaccination Status and Mortality Among Intubated Patients With COVID-19–Related Acute Respiratory Distress Syndrome

et al. 2022

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“…In a study in the USA, during the first 6 months of the pandemic, the mortality rates were strongly associated with the prevalence of COVID-19 in the hospital's surrounding communities, but neither the number of intensive care unit beds nor academic status was relevant [ 4 ]. Another USA report suggested that treatment at a hospital dedicated to COVID-19 care performed better in terms of the survival rates of patients with severe COVID-19 [ 5 ]. In that study, mortality rates were higher in specialized hospitals, but multivariate adjustment verified that their outcomes were better when patients' severity was accounted for.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the clinical characteristics and outcomes of Japanese patients with COVID-19 treated in primary, secondary, and tertiary care facilities

Tomidokoro¹,

Asai²,

Hayakawa³

et al. 2023

Journal of Infection and Chemotherapy

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“…Additionally hospital treated participants received immunotherapy, plasma therapy, ventilator use, and steroids. It has previously been reported that significantly higher doses of corticosteroids, remdesivir, and tocilizumab have been used in patients of COVID-hospitals than non-COVID-hospitals ( 53 ). In the current study immunotherapy was only administered to severely infected patients who had received hospital treatment.…”

Section: Discussionmentioning

confidence: 99%

Post-COVID-19 complications in home and hospital-based care: A study from Dhaka city, Bangladesh

Khandker

Akther²,

Syed³

et al. 2022

Front. Rehabilit. Sci.

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A cross-sectional survey was undertaken to understand the management patterns and post-COVID-19 complications among hospital and home-treated participants. Retrospective information was collected from four COVID-19 dedicated hospitals and four selected community settings. Using probability proportional sampling, 925 participants were selected. Data were collected using a semi-structured questionnaire. Bivariate and multivariate logistic regression analysis and the exact chi-square tests were utilized to analyze the association between the studied variables. A total of 659 participants responded (response rate 70.93%); 375 from hospitals and 284 from communities. About 80% of participants were mild cases, 75% were treated at home, and 65% of hospital-treated participants were referred after home treatment. Participants treated at home-to hospital and directly in the hospital had 1.64 and 3.38 times longer recovery time respectively than what home-based participants had. A significant increasing trend (p < 0.001) of co-morbidities was found among referred and hospital treated participants. Age, level of education, physical exercise, practicing preventive measures, exposure to sunlight, and intake of carbohydrate, additional liquid, food supplements, and avoidance of junk foods were significantly associated with place of treatment. Post-COVID-19 difficulties of all factors were statistically significant for home treatment participants, whilst only depression (p = 0.026), chest pain (p = 0.017), and digestive disorders (p = 0.047) were significant (p < 0.05) for hospital treated participants. The outcomes from this study provide insight into a range of post-COVID-19 difficulties relating to at home and in hospital treatment participants. There are clear differences in the complications experienced, many of which are statistically significant. The health care professionals, the community people and COVID-19 survivors will be benefitted from the study findings, and the policy level people may use the information for designing health education program on post COVID-19 complications.

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Comparison of Outcomes and Process of Care for Patients Treated at Hospitals Dedicated for COVID-19 Care vs Other Hospitals

Cited by 9 publications

References 25 publications

Association Between Vaccination Status and Mortality Among Intubated Patients With COVID-19–Related Acute Respiratory Distress Syndrome

Association Between Vaccination Status and Mortality Among Intubated Patients With COVID-19–Related Acute Respiratory Distress Syndrome

Comparison of the clinical characteristics and outcomes of Japanese patients with COVID-19 treated in primary, secondary, and tertiary care facilities

Post-COVID-19 complications in home and hospital-based care: A study from Dhaka city, Bangladesh

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