Open AccessLength of Stay in ICU of Covid-19 Patients in England, March - May 2020
Author(s) -
Nick Shryane,
María Pampaka,
Andrea Aparicio-Castro,
Shazaad Ahmad,
Mark Elliot,
Jihye Kim,
Jennifer Murphy,
Wendy Olsen,
Diego Andrés Pérez Ruiz,
Arkadiusz Wiśniowski
Publication year - 2021
Publication title -
international journal of population data science
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 7
ISSN - 2399-4908
DOI - 10.23889/ijpds.v5i4.1411
Subject(s) - medicine , covid-19 , pandemic , extracorporeal membrane oxygenation , emergency medicine , intensive care , censoring (clinical trials) , retrospective cohort study , pediatrics , intensive care medicine , disease , infectious disease (medical specialty) , pathology
Length of Stay (LoS) in Intensive Care Units (ICUs) is an important measure for planning beds capacity during the Covid-19 pandemic. However, as the pandemic progresses and we learn more about the disease, treatment and subsequent LoS in ICU may change.ObjectivesTo investigate the LoS in ICUs in England associated with Covid-19, correcting for censoring, and to evaluate the effect of known predictors of Covid-19 outcomes on ICU LoS.Data sourcesWe used retrospective data on Covid-19 patients, admitted to ICU between 6 March and 24 May, from the “Covid-19 Hospitalisation in England Surveillance System” (CHESS) database, collected daily from England’s National Health Service, and collated by Public Health England.MethodsWe used Accelerated Failure Time survival models with Weibull and log-normal distributional assumptions to investigate the effect of predictors, which are known to be associated with poor Covid-19 outcomes, on the LoS in ICU.ResultsPatients admitted before 25 March had significantly longer LoS in ICU (mean = 18.4 days, median = 12), controlling for age, sex, whether the patient received Extracorporeal Membrane Oxygenation, and a co-morbid risk factors score, compared with the period after 7 April (mean = 15.4, median = 10). The periods of admission reflected the changes in the ICU admission policy in England. Patients aged 50-65 had the longest LoS, while higher co-morbid risk factors score led to shorter LoS. Sex and ethnicity were not associated with ICU LoS.ConclusionsThe skew of the predicted LoS suggests that a mean LoS, as compared with median, might be better suited as a measure used to assess and plan ICU beds capacity. This is important for the ongoing second and any future waves of Covid-19 cases and potential pressure on the ICU resources. Also, changes in the ICU admission policy are likely to be confounded with improvements in clinical knowledge of Covid-19.