Abstract
Objective: To describe patient characteristics, symptoms, patterns of care and outcomes for patients hospitalised with COVID-19 in Michigan.
Design: Multicentre retrospective cohort study.
Setting: 32 acute care hospitals in the state of Michigan.
Participants: Patients discharged (16 March-11 May 2020) with suspected or confirmed COVID-19 were identified. Trained abstractors collected demographic information on all patients and detailed clinical data on a subset of COVID-19-positive patients.
Primary outcome measurements: Patient characteristics, treatment and outcomes including cardiopulmonary resuscitation, mortality and venous thromboembolism within and across hospitals.
Results: Demographic-only data from 1593 COVID-19-positive and 1259 persons under investigation discharges were collected. Among 1024 cases with detailed data, the median age was 63 years; median body mass index was 30.6; and 51.4% were black. Cough, fever and shortness of breath were the top symptoms. 37.2% reported a known COVID-19 contact; 7.0% were healthcare workers; and 16.1% presented from congregated living facilities.During hospitalisation, 232 (22.7%) patients were treated in an intensive care unit (ICU); 558 (54.9%) in a ‘cohorted’ unit; 161 (15.7%) received mechanical ventilation; and 90 (8.8%) received high-flow nasal cannula. ICU patients more often received hydroxychloroquine (66% vs 46%), corticosteroids (34% vs 18%) and antibiotic therapy (92% vs 71%) than general ward patients (p<0.05 for all). Overall, 219 (21.4%) patients died, with in-hospital mortality ranging from 7.9% to 45.7% across hospitals. 73% received at least one COVID-19-specific treatment, ranging from 32% to 96% across sites.Across 14 hospitals, the proportion of patients admitted directly to an ICU ranged from 0% to 43.8%; mechanical ventilation on admission from 0% to 12.8%; mortality from 7.9% to 45.7%. Use of at least one COVID-19-specific therapy varied from 32% to 96.3% across sites.
Conclusions: During the early days of the Michigan outbreak of COVID-19, patient characteristics, treatment and outcomes varied widely within and across hospitals.
Keywords: COVID-19; protocols & guidelines; quality in healthcare.
【저자키워드】 COVID-19, protocols &, guidelines, quality in healthcare, 【초록키워드】 Corticosteroid, Treatment, therapy, protocol, Mortality, Hydroxychloroquine, intensive care, mechanical ventilation, hospital, Cardiopulmonary, nasal, outcome, Venous Thromboembolism, Symptoms, discharge, ICU, hospitals, body mass index, Characteristics, outbreak, healthcare, Fever, Patient, age, information, hospitalisation, Admission, Care, patients, in-hospital mortality, Shortness of breath, retrospective cohort study, Antibiotic therapy, Clinical data, hospitalised, ICU patient, collected, proportion, reported, median, treated, subset, discharged, ranged, patients died, the median, with COVID-19, 【제목키워드】 Treatment, hospital, outcome, Characteristics,