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- COVID-19 complications
- COVID-19 mortality
- code status downgrade
- acute respiratory failure
- outcomes research
- hospital admission.
Introduction
The SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic has challenged health-care systems worldwide. Although research surrounding COVID-19 has primarily focused on management and treatment principles,1-3 many studies have sought to categorize the nature of the disease and highlight patient factors that may increase mortality from COVID-19.4-6 Although data exist that outline epidemiological and mortality factors for hospital admissions with COVID-19,4,7,8 there remains a gap in the full characterization of these patients’ admissions. This study explored COVID-19 admissions to extrapolate on the relationships between the high mortality rate of COVID-19 and medical complications that present during patient admissions. The study’s objectives were to investigate the severity and impact of patient complications on mortality, and to explore the relationship between these complications, code status downgrades (defined as a de-escalation of code status from full code to either limited intervention or comfort care), and mortality. These factors highlight the impact of COVID-19 on discussions about palliative care and informed code status downgrades.
Methods
A retrospective chart review was conducted of 346 patients who presented to the emergency department or who transferred from outside hospital emergency departments for admission due to symptoms related to COVID-19 at a tertiary medical health-care system in central North Carolina. A custom REDCap (Research Electronic Data Capture system)9,10 was used to track individual admissions, demographics (sex, age, body mass index), preexisting comorbidities (active cancer, hypertension history, diabetes), hospital course, and eventual disposition. The study was approved under expedited review category 5 by the institutional review board of the study’s home institution (approval 00066056).
Patient presentations for COVID-19 hospital admissions were identified from March 22, 2020, to June 30, 2020. Adult and pediatric patients met inclusion criteria if they were admitted for suspected COVID-19-related respiratory illness …
Correspondence: David M Cline MD, Department of Emergency Medicine, Atrium Health Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston Salem, NC 27157. E-mail: dcline{at}wakehealth.edu
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