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Pre-Hospital Management of Patients with COVID-19 and the Impact on Hospitalization

Background and Objectives: During the COVID-19 pandemic, patient care was mainly organized around the hospital. Pre-hospital care has, to our knowledge, never been evaluated. We aimed to study the impact of pre-hospital pathways on hospitalization during the last part of the pandemic. Materials and...

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Autores principales: Grannec, Floann, Meddeb, Line, Tissot-Dupont, Herve, Gentile, Stephanie, Brouqui, Philippe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10456276/
https://www.ncbi.nlm.nih.gov/pubmed/37629730
http://dx.doi.org/10.3390/medicina59081440
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author Grannec, Floann
Meddeb, Line
Tissot-Dupont, Herve
Gentile, Stephanie
Brouqui, Philippe
author_facet Grannec, Floann
Meddeb, Line
Tissot-Dupont, Herve
Gentile, Stephanie
Brouqui, Philippe
author_sort Grannec, Floann
collection PubMed
description Background and Objectives: During the COVID-19 pandemic, patient care was mainly organized around the hospital. Pre-hospital care has, to our knowledge, never been evaluated. We aimed to study the impact of pre-hospital pathways on hospitalization during the last part of the pandemic. Materials and Methods: This was a monocentric, retrospective analysis of prospectively collected medical records. Data from patients admitted to our institute between 1 February and 7 March 2022 were analyzed. The primary outcomes were defined as the number of hospitalizations, resuscitations, and deaths at the time of interview and in the subsequent 30 days. The main explanatory variables were times from onset of symptoms to care, age, gender, News2 score, comorbidities, and pre-hospital pathways and their duration. Results: Three pre-hospital pathways were identified: a pathway in which the patient consults a general practitioner for a test (PHP1); a pathway in which the patient consults for care (PHP2); and no pre-hospital pathway and direct admission to hospital (PHP3). Factors independently associated with outcome (hospitalization) were being male (OR 95% CI; 2.21 (1.01–4.84), p = 0,04), News2 score (OR 95% CI; 2.04 (1.65–2.51), p < 0.001), obesity (OR 95% CI; 3.45 (1.48–8.09), p = 0.005), D-dimers > 0.5 µg/mL (OR 95% CI; 3.45 (1.47–8.12), p = 0.005), and prolonged time from symptoms to hospital care (PHP duration) (OR 95% CI; 1.07 (1.01–1.14), p = 0.03). All things being equal, patients with a “PHP2” pre-hospital pathway had a higher probability of hospitalization compared to those with a “PHP3” pre-hospital pathway (OR 95% CI; 4.31 (1.48–12.55), p = 0.007). Conclusions: Along with recognized risk factors such as gender, News 2 score, and obesity, the patient’s pre-hospital pathway is an important risk factor associated with hospitalization.
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spelling pubmed-104562762023-08-26 Pre-Hospital Management of Patients with COVID-19 and the Impact on Hospitalization Grannec, Floann Meddeb, Line Tissot-Dupont, Herve Gentile, Stephanie Brouqui, Philippe Medicina (Kaunas) Article Background and Objectives: During the COVID-19 pandemic, patient care was mainly organized around the hospital. Pre-hospital care has, to our knowledge, never been evaluated. We aimed to study the impact of pre-hospital pathways on hospitalization during the last part of the pandemic. Materials and Methods: This was a monocentric, retrospective analysis of prospectively collected medical records. Data from patients admitted to our institute between 1 February and 7 March 2022 were analyzed. The primary outcomes were defined as the number of hospitalizations, resuscitations, and deaths at the time of interview and in the subsequent 30 days. The main explanatory variables were times from onset of symptoms to care, age, gender, News2 score, comorbidities, and pre-hospital pathways and their duration. Results: Three pre-hospital pathways were identified: a pathway in which the patient consults a general practitioner for a test (PHP1); a pathway in which the patient consults for care (PHP2); and no pre-hospital pathway and direct admission to hospital (PHP3). Factors independently associated with outcome (hospitalization) were being male (OR 95% CI; 2.21 (1.01–4.84), p = 0,04), News2 score (OR 95% CI; 2.04 (1.65–2.51), p < 0.001), obesity (OR 95% CI; 3.45 (1.48–8.09), p = 0.005), D-dimers > 0.5 µg/mL (OR 95% CI; 3.45 (1.47–8.12), p = 0.005), and prolonged time from symptoms to hospital care (PHP duration) (OR 95% CI; 1.07 (1.01–1.14), p = 0.03). All things being equal, patients with a “PHP2” pre-hospital pathway had a higher probability of hospitalization compared to those with a “PHP3” pre-hospital pathway (OR 95% CI; 4.31 (1.48–12.55), p = 0.007). Conclusions: Along with recognized risk factors such as gender, News 2 score, and obesity, the patient’s pre-hospital pathway is an important risk factor associated with hospitalization. MDPI 2023-08-09 /pmc/articles/PMC10456276/ /pubmed/37629730 http://dx.doi.org/10.3390/medicina59081440 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Grannec, Floann
Meddeb, Line
Tissot-Dupont, Herve
Gentile, Stephanie
Brouqui, Philippe
Pre-Hospital Management of Patients with COVID-19 and the Impact on Hospitalization
title Pre-Hospital Management of Patients with COVID-19 and the Impact on Hospitalization
title_full Pre-Hospital Management of Patients with COVID-19 and the Impact on Hospitalization
title_fullStr Pre-Hospital Management of Patients with COVID-19 and the Impact on Hospitalization
title_full_unstemmed Pre-Hospital Management of Patients with COVID-19 and the Impact on Hospitalization
title_short Pre-Hospital Management of Patients with COVID-19 and the Impact on Hospitalization
title_sort pre-hospital management of patients with covid-19 and the impact on hospitalization
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10456276/
https://www.ncbi.nlm.nih.gov/pubmed/37629730
http://dx.doi.org/10.3390/medicina59081440
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