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Impact of COVID-19 on non-COVID intensive care unit service utilization, case mix and outcomes: A registry-based
, Neill Kj Adhikari1, Abi Beane2
1Intedepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
Insights
The COVID-19 pandemic significantly disrupted critical care services in India, leading to fewer admissions but increased patient severity and mortality in non-COVID intensive care units (ICUs). Healthcare utilization saw major changes during this period.
Area of Science:
- Critical Care Medicine
- Epidemiology
- Public Health
Background:
- The COVID-19 pandemic caused over 3.4 million global deaths and 25 million cases in India.
- India implemented a nationwide lockdown, prioritizing COVID-19 care and impacting general healthcare services.
- Understanding the pandemic's effect on non-COVID intensive care units (ICUs) is crucial for healthcare planning.
Purpose of the Study:
- To analyze the impact of the COVID-19 pandemic on critical care service utilization.
- To assess changes in patient case-mix, acuity, and clinical outcomes in non-COVID ICUs.
- To evaluate the effects of the pandemic and lockdown on ICU bed demand and resource availability.
Main Methods:
- Data from the Indian Registry of IntenSive care was used for patients admitted between October 2019 and September 2020.
- Patients admitted to non-COVID or general ICUs were included in the analysis.
- A Mann-Whitney test compared pre-pandemic (Oct 2019-Feb 2020) and pandemic (Mar-Sep 2020) periods, including an intense lockdown phase (Mar-May 2020).
Main Results:
- Weekly ICU admissions and unit turnover declined significantly during the pandemic period (p<0.001).
- Patient acuity, measured by APACHE II score, increased (p<0.001), and unadjusted ICU mortality rose from 9.3% to 11.7% (p=0.015).
- The length of ICU stay remained similar between the periods (p=0.151).
Conclusions:
- The COVID-19 pandemic caused substantial disruptions in healthcare utilization for non-COVID critical care.
- There was a notable increase in the severity of illness among patients admitted to general ICUs.
- These findings highlight the need for robust critical care infrastructure to manage pandemics without compromising routine care.
Abstract:
Background: Coronavirus disease 2019 (COVID-19) has been responsible for over 3.4 million deaths globally and over 25 million cases in India. As part of the response, India imposed a nation-wide lockdown and prioritized COVID-19 care in hospitals and intensive care units (ICUs). Leveraging data from the Indian Registry of IntenSive care, we sought to understand the impact of the COVID-19 pandemic on critical care service utilization, case-mix, and clinical outcomes in non-COVID ICUs. Methods: We included all consecutive patients admitted between 1 st October 2019 and 27 th September 2020. Data were extracted from the registry database and included patients admitted to the non-COVID or general ICUs at each of the sites. Outcomes included measures of resource-availability, utilisation, case-mix, acuity, and demand for ICU beds. We used a Mann-Whitney test to compare the pre-pandemic period (October 2019 - February 2020) to the pandemic period (March-September 2020). In addition, we also compared the period of intense lockdown (March-May 31 st 2020) with the pre-pandemic period. Results: There were 3424 patient encounters in the pre-pandemic period and 3524 encounters in the pandemic period. Comparing these periods, weekly admissions declined (median [Q1 Q3] 160 [145,168] to 113 [98.5,134]; p<0.001); unit turnover declined (median [Q1 Q3] 12.1 [11.32,13] to 8.58 [7.24,10], p<0.001), and APACHE II score increased (median [Q1 Q3] 19 [19,20] to 21 [20,22] ; p<0.001). Unadjusted ICU mortality increased (9.3% to 11.7%, p=0.015) and the length of ICU stay was similar (median [Q1 Q3] 2.11 [2, 2] vs. 2.24 [2, 3] days; p=0.151). Conclusion: Our registry-based analysis of the impact of COVID-19 on non-COVID critical care demonstrates significant disruptions to healthcare utilization during the pandemic and an increase in the severity of illness.
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