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Pre-Hospital Management of Patients with COVID-19 and the Impact on Hospitalization
Floann Grannec1, Line Meddeb2, Herve Tissot-Dupont2
1IRD, MEPHI, IHU-Méditerranée Infection, Aix Marseille Université, 13005 Marseille, France.
Insights
The patient's pre-hospital pathway significantly impacts hospitalization risk, alongside factors like gender and obesity. Understanding these pathways is crucial for managing patient care during health crises.
Area of Science:
- Medical Research
- Public Health
- Epidemiology
Background:
- COVID-19 pandemic shifted patient care focus to hospitals.
- Pre-hospital care pathways have not been previously evaluated.
- This study addresses the gap in understanding pre-hospital care's role during the pandemic.
Purpose of the Study:
- To investigate the influence of pre-hospital care pathways on patient hospitalization.
- To identify factors associated with hospitalization during the later stages of the COVID-19 pandemic.
Main Methods:
- Retrospective analysis of prospectively collected medical records from a single institution.
- Inclusion criteria: patients admitted between February 1 and March 7, 2022.
- Key variables: time to care, demographics, News2 score, comorbidities, and pre-hospital pathway details.
Main Results:
- Three pre-hospital pathways (PHP1, PHP2, PHP3) were identified.
- Independent predictors of hospitalization included male gender, elevated News2 score, obesity, high D-dimers, and prolonged symptom-to-hospital time.
- Patients utilizing the 'PHP2' pathway (consulting for care) showed a higher hospitalization probability than those with direct admission (PHP3).
Conclusions:
- Pre-hospital pathway is a significant risk factor for hospitalization, comparable to established factors like gender, News2 score, and obesity.
- Findings highlight the importance of optimizing pre-hospital care strategies.
- Further research into pre-hospital care's impact on patient outcomes is warranted.
Abstract:
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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