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Retrospective cohort study of admission timing and mortality following COVID-19 infection in England
OBJECTIVES: We investigated whether the timing of hospital admission is associated with the risk of mortality for patients with COVID-19 in England, and the factors associated with a longer interval between symptom onset and hospital admission. DESIGN: Retrospective observational cohort study of dat...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7684820/ https://www.ncbi.nlm.nih.gov/pubmed/33234660 http://dx.doi.org/10.1136/bmjopen-2020-042712 |
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author | Alaa, Ahmed Qian, Zhaozhi Rashbass, Jem Benger, Jonathan van der Schaar, Mihaela |
author_facet | Alaa, Ahmed Qian, Zhaozhi Rashbass, Jem Benger, Jonathan van der Schaar, Mihaela |
author_sort | Alaa, Ahmed |
collection | PubMed |
description | OBJECTIVES: We investigated whether the timing of hospital admission is associated with the risk of mortality for patients with COVID-19 in England, and the factors associated with a longer interval between symptom onset and hospital admission. DESIGN: Retrospective observational cohort study of data collected by the COVID-19 Hospitalisation in England Surveillance System (CHESS). Data were analysed using multivariate regression analysis. SETTING: Acute hospital trusts in England that submit data to CHESS routinely. PARTICIPANTS: Of 14 150 patients included in CHESS until 13 May 2020, 401 lacked a confirmed diagnosis of COVID-19 and 7666 lacked a recorded date of symptom onset. This left 6083 individuals, of whom 15 were excluded because the time between symptom onset and hospital admission exceeded 3 months. The study cohort therefore comprised 6068 unique individuals. MAIN OUTCOME MEASURES: All-cause mortality during the study period. RESULTS: Timing of hospital admission was an independent predictor of mortality following adjustment for age, sex, comorbidities, ethnicity and obesity. Each additional day between symptom onset and hospital admission was associated with a 1% increase in mortality risk (HR 1.01; p<0.005). Healthcare workers were most likely to have an increased interval between symptom onset and hospital admission, as were people from Black, Asian and minority ethnic (BAME) backgrounds, and patients with obesity. CONCLUSION: The timing of hospital admission is associated with mortality in patients with COVID-19. Healthcare workers and individuals from a BAME background are at greater risk of later admission, which may contribute to reports of poorer outcomes in these groups. Strategies to identify and admit patients with high-risk and those showing signs of deterioration in a timely way may reduce the consequent mortality from COVID-19, and should be explored. |
format | Online Article Text |
id | pubmed-7684820 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-76848202020-11-30 Retrospective cohort study of admission timing and mortality following COVID-19 infection in England Alaa, Ahmed Qian, Zhaozhi Rashbass, Jem Benger, Jonathan van der Schaar, Mihaela BMJ Open Infectious Diseases OBJECTIVES: We investigated whether the timing of hospital admission is associated with the risk of mortality for patients with COVID-19 in England, and the factors associated with a longer interval between symptom onset and hospital admission. DESIGN: Retrospective observational cohort study of data collected by the COVID-19 Hospitalisation in England Surveillance System (CHESS). Data were analysed using multivariate regression analysis. SETTING: Acute hospital trusts in England that submit data to CHESS routinely. PARTICIPANTS: Of 14 150 patients included in CHESS until 13 May 2020, 401 lacked a confirmed diagnosis of COVID-19 and 7666 lacked a recorded date of symptom onset. This left 6083 individuals, of whom 15 were excluded because the time between symptom onset and hospital admission exceeded 3 months. The study cohort therefore comprised 6068 unique individuals. MAIN OUTCOME MEASURES: All-cause mortality during the study period. RESULTS: Timing of hospital admission was an independent predictor of mortality following adjustment for age, sex, comorbidities, ethnicity and obesity. Each additional day between symptom onset and hospital admission was associated with a 1% increase in mortality risk (HR 1.01; p<0.005). Healthcare workers were most likely to have an increased interval between symptom onset and hospital admission, as were people from Black, Asian and minority ethnic (BAME) backgrounds, and patients with obesity. CONCLUSION: The timing of hospital admission is associated with mortality in patients with COVID-19. Healthcare workers and individuals from a BAME background are at greater risk of later admission, which may contribute to reports of poorer outcomes in these groups. Strategies to identify and admit patients with high-risk and those showing signs of deterioration in a timely way may reduce the consequent mortality from COVID-19, and should be explored. BMJ Publishing Group 2020-11-23 /pmc/articles/PMC7684820/ /pubmed/33234660 http://dx.doi.org/10.1136/bmjopen-2020-042712 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Infectious Diseases Alaa, Ahmed Qian, Zhaozhi Rashbass, Jem Benger, Jonathan van der Schaar, Mihaela Retrospective cohort study of admission timing and mortality following COVID-19 infection in England |
title | Retrospective cohort study of admission timing and mortality following COVID-19 infection in England |
title_full | Retrospective cohort study of admission timing and mortality following COVID-19 infection in England |
title_fullStr | Retrospective cohort study of admission timing and mortality following COVID-19 infection in England |
title_full_unstemmed | Retrospective cohort study of admission timing and mortality following COVID-19 infection in England |
title_short | Retrospective cohort study of admission timing and mortality following COVID-19 infection in England |
title_sort | retrospective cohort study of admission timing and mortality following covid-19 infection in england |
topic | Infectious Diseases |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7684820/ https://www.ncbi.nlm.nih.gov/pubmed/33234660 http://dx.doi.org/10.1136/bmjopen-2020-042712 |
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