Inter‐hospital transfer and clinical outcomes for people with COVID‐19 admitted to intensive care units in Australia: an observational cohort study

Abstract

Objectives To examine the association between inter‐hospital transfer and in‐hospital mortality among people with coronavirus disease 2019 (COVID‐19) admitted to intensive care units (ICUs) in Australia. Design Retrospective cohort study; analysis of data collected for the Short Period Incidence Study of Severe Acute Respiratory Illness (SPRINT‐SARI) Australia study. Setting, participants People with COVID‐19 admitted to 63 ICUs, 1 January 2020 – 1 April 2022. Main outcome measures Primary outcome: in‐hospital mortality; secondary outcomes: ICU and hospital lengths of stay and frequency of selected complications. Results Of 5207 people with records in the SPRINT‐SARI Australia database at 1 April 2022, 328 (6.3%) had been transferred between hospitals, 305 (93%) during the third pandemic wave. Compared with patients not transferred, their median age was lower (53 years; interquartile range [IQR], 45–61 years v 60 years; IQR, 46–70 years), their median body mass index higher (32.5 [IQR, 27.2–39.0] kg/m2 v 30.1 [IQR, 25.7–35.7] kg/m2), and fewer had received a COVID‐19 vaccine (22% v 44.9%); their median APACHE II scores were similar (14.0; IQR, 12.0–18.0 v 14.0; IQR, 10.0–19.0). Bacterial pneumonia (64.7% v 29.0%) and bacteraemia (27% v 8%) were more frequent in transferred patients, as was the need for more intensive ICU interventions, including invasive mechanical ventilation (71.2% v 38.1%) and extra‐corporeal membrane oxygenation (26% v 1.7%). Crude ICU (19% v 14.9%) and in‐hospital mortality (19% v 18.4%) were similar for patients who were or were not transferred; median lengths of ICU (20.0 [IQR, 11.2–40.3] days v 4.6 [IQR, 2.1–10.1] days) and hospital stay (29.7 [IQR, 18.1–49.6] days v 12.3 [IQR, 7.3–21.0] days) were longer for transferred patients. In the multivariable regression analysis, in‐hospital mortality risk was lower for transferred patients (risk difference [RD], –5.0 percentage points; 95% confidence interval [CI] –10 to –0.03 percentage points), but not in the propensity score‐adjusted analysis (RD, –3.4 [95% CI, –8.9 to 2.1] percentage points). Conclusions Among people with COVID‐19 admitted to ICUs, patients transferred from another hospital required more intense interventions and remained in hospital longer, but were not at greater risk of dying in hospital than the patients who were not transferred.

Period of hospitalization and mortality in transferred versus non-transferred COVID-19 patients: Results from Germany

“…The separate analysis was necessary, as ICU patients were relatively more often transferred and at the same time showed a much higher mortality than non-ICU patients. The nding regarding mortality of transferred ICU patients is in line with the great majority of the previous studies on mortality in ICU patients performed in different countries at different periods of time [5,7,8,[11][12][13], suggesting the validity and comparability of our data. When focusing on the mortality of non-ICU patients, our results appear novel but compatible with the literature, as in a previous study [5] no higher mortality of transferred patients was observed, when pooling ICU and non-ICU patients after adjustment for several risk factors.…”

“…The transfer of patients was guided by their individual characteristics and the capabilities of the hospitals involved but also undertaken preventively to restore capacities, especially regarding intensive care units (ICU). Several studies analyzed whether the transfer of ICU patients was linked to mortality [5,7,[11][12][13], with the common result that no adversely effect could be found, with one exception, mentioning even an improved survival for inter-regional transferred ICU patients compared to non-transferred patients during the rst COVID-19 wave in France [8]. In addition to mortality, the period of hospitalization is of major interest, as a longer stay may increase shortages of hospital beds, which was also implied by a study without the possibility of veri cation [8].…”

The inter‐hospital transfer of critically ill patients with COVID‐19: a double‐edged sword

“…However, transferred patients required more intense interventions and complications were more frequent, and their median lengths of intensive care unit and hospital stay were each longer. In their regression analysis, the authors found a small survival benefit for transferred patients, but not after propensity score‐based adjustment 12 …”

“…In this issue of the Journal, Cini and colleagues 12 report their retrospective observational study of patients critically ill with COVID‐19. By April 2022, 328 of 5207 people with COVID‐19 admitted to intensive care units (6.3%) had been transferred between hospitals.…”

Standardization of a CT Protocol for Imaging Patients with Suspected COVID-19—A RACOON Project

“…Nevertheless, variations in CT protocol parameter settings can significantly impact IQ, posing potential challenges. Problems can arise when patients are transferred between different hospitals or when they receive a follow-up scan months later at a different hospital to investigate any post-infectious parenchymal alterations related to long COVID [ 14 , 15 ].…”