Background: L’OMS definisce la COVID-19 come “malattia infettiva data da un coronavirus di nuova scoperta”. Sviluppatasi in Cina nel dicembre 2019è stata dichiarata pandemia l’11 marzo 2020. Questa emergenza ha avuto un serio impatto sul sistema sanitario italiano, il secondo paese più colpito su scala globale, con ampio impatto sui servizi di emergenza (PS) che hanno dovuto far fronte a un forte aumento di accessi di pazienti COVID-19. Una riorganizzazione strutturale e miglioramenti nell’allocazione delle risorse si sono resi necessari per far fronte a questa situazione improvvisa, contenere i picchi infettivi e prevenire il sovraccarico delle strutture sanitarie. Disegno e obiettivi dello studio: Lo scopo di questo studio osservazionale retrospettivo di coorte è analizzare e confrontare le caratteristiche di 751 pazienti COVID-19 ammessi al PS dell'ospedale S. Luigi Gonzaga durante le prime due ondate di pandemia, rispettivamente 1 marzo-30 aprile e 1 ottobre-17 dicembre 2020. Tramite analisi univariata sono state valutate le differenze in caratteristiche demografiche, comorbilità, parametri di triage, esami di imaging, test di laboratorio, necessità di ricovero e mortalità. Tramite regressione logistica abbiamo valutato l’associazione delle variabili suddette con la dimissione dal PS e con la mortalità intraospedaliera. Risultati: gli accessi di pazienti positivi sono raddoppiati nella seconda ondata ( 3,67 al giorno contro 6,76) e l’età media di tali soggetti era minore (64vs65,65 anni, p=0,021). Analizzandone le comorbilità, nella seconda ondata sono stati osservati più pazienti con Charlson Comorbidity Index >1, mentre si sono ridotto quelli con CCI=1. La quota di pazienti sintomatici è passata da 99,5% a 91% (p<0,001), con sintomi più lievi; il triage infermieristico ha mostrato riduzione nei codici gialli/rossi a fronte di un aumento dei bianchi/verdi. Molti casi ammessi in prima ondata presentavano ecografia o TC torace non patologici, mentre in autunno sono stati registrati più reperti positivi; l’rx torace ha mostrato invece un aumento di referti negativi nel secondo periodo. Oltre ai maggiori valori di PCR riportati nella seconda ondata non sono emerse differenze sostanziali negli esami di laboratorio. La necessità di supporto respiratorio è calata da 50,9% a 40,9% (p=0,013), il tasso di dimissioni è cresciuto (32,6%vs46,5%, p<0,001) e sono diminuiti i ricoveri (65,6%vs52%, p<0,001), a loro volta aumentati nelle medicine interne e ridotti in terapia intensiva o seminitensiva. Nonostante non abbia raggiunto la significatività, è stato mostrato un calo nella mortalità intraospedaliera e nella durata della degenza. L'analisi multivariata evidenzia che mentre età e CCI aumentano il rischio di ricovero (OR 1,08[1,07-1,10] e 1,55[1,29-1,91]) l’accesso in PS in seconda ondata è protettivo (OR 0,6[0,39-0,91)). Inoltre i pazienti anziani, con CCI>=1 e valutati come gialli/rossi al triage presentano un maggior rischio di morte intraospedaliera. Conclusioni: lo studio evidenzia che la popolazione ammessa in PS nei due periodi di pandemia è cambiata in caratteristiche demografiche e cliniche, nonché in esiti a breve e medio termine. I pazienti ammessi nella seconda ondata erano più giovani e con sintomi più lievi; quando ricoverati, la degenza era più breve, i tassi di mortalità minori e i trattamenti meno intensivi.
Background: WHO defined COVID-19 as “infectious disease caused by a newly discovered coronavirus”. Emerged in China in December 2019, it was declared a pandemic in March 2020 and strongly impacted the Italian health system, the second most affected Country on a global scale. Emergency departments (ED) were particularly affected, facing a sharp increase in admissions of patients with COVID-19. A structural reorganization and improvements in resource allocation were needed to cope with this sudden situation, to contain peaks in infections and preventing healthcare facilities overload. Study design and aims: The aim of this retrospective observational cohort study is to analyse and compare the characteristics of 751 COVID-19 patients accessing the ED of S. Luigi Gonzaga hospital during the two first pandemic waves, respectively March 1st-April 30th and October 1st-December 17th, 2020. The study focuses on investigating, by univariate analysis, variations in demographical characteristics, underlying comorbidities, triage parameters, imaging exams, laboratory tests, ED outcome and hospital outcomes (hospital mortality and length of stay) over the course of the pandemic. Then, we evaluated by multivariable logistic regression the association between patients’ characteristics and period of arrival with the above described outcomes. Results: patients positives to RT-PCR doubled in the second wave (3,67 vs 6,76 per day) and had a lower median age (64 vs 65.65 years old, p=0.021). Analysing underlying comorbidities, more subjects with a Charlson Comorbidity Index >1 were observed in the second wave, associated to a decrease in patients with a CCI=1. Triage evaluation showed a reduction of immediate/urgent codes in the second wave, with a higher percentage of patients assessed as delayed/expectant. The number of symptomatic patients shifted from 99.5% to 91% in October-November (p<0.001) and symptoms were milder. Many cases in the first wave presented not-pathological LUS and chest CT, while a higher number of positive findings was recorded in the second. Contrarily, chest X-Ray showed an increase in negative findings in the second period. Apart from a higher CRP value in the second wave, no substantial differences emerged in laboratory values. The necessity of respiratory support went through a reduction, shifting from 50.9% to 40.9% (p=0.013). Discharge rate rose in the second wave (32.6% vs 46.5%, p<0.001), hospitalizations decreased (65.6% vs 52%, p<0.001), registering more admissions in internal medicine wards along with a decline in admissions in ICU or sub-intensive care wards. Despite the trend did not reach significance, a lowering of hospital mortality and length of stay was observed as well. Multivariate analysis showed that age and CCI increased the risk of hospital admission (OR 1.08 [1.07-1.10] and 1.55 [1.29-1.91]), while accessing the ED in the second wave was a protective factor (OR 0.6[0.39-0.91]). Further, elderly patients, with a CCI>=1 and immediate/urgent at triage assessment had a higher risk of hospital death. Conclusions: The study evidenced that population accessing the ED during the first and the second pandemic periods differed in demographical and clinical characteristics as well as short and mid-term outcomes. Patients admitted in the second wave were younger with a milder illness; if hospitalized required fewer days to recover, had lower mortality rates and treatments were less intensive.
Pazienti con COVID-19 ammessi al Pronto Soccorso dell'ospedale San Luigi Gonzaga - confronto demografico, clinico, terapeutico e di outcome tra prima seconda ondata di pandemia, studio osservazionale
ROETTI, SARA
2020/2021
Abstract
Background: WHO defined COVID-19 as “infectious disease caused by a newly discovered coronavirus”. Emerged in China in December 2019, it was declared a pandemic in March 2020 and strongly impacted the Italian health system, the second most affected Country on a global scale. Emergency departments (ED) were particularly affected, facing a sharp increase in admissions of patients with COVID-19. A structural reorganization and improvements in resource allocation were needed to cope with this sudden situation, to contain peaks in infections and preventing healthcare facilities overload. Study design and aims: The aim of this retrospective observational cohort study is to analyse and compare the characteristics of 751 COVID-19 patients accessing the ED of S. Luigi Gonzaga hospital during the two first pandemic waves, respectively March 1st-April 30th and October 1st-December 17th, 2020. The study focuses on investigating, by univariate analysis, variations in demographical characteristics, underlying comorbidities, triage parameters, imaging exams, laboratory tests, ED outcome and hospital outcomes (hospital mortality and length of stay) over the course of the pandemic. Then, we evaluated by multivariable logistic regression the association between patients’ characteristics and period of arrival with the above described outcomes. Results: patients positives to RT-PCR doubled in the second wave (3,67 vs 6,76 per day) and had a lower median age (64 vs 65.65 years old, p=0.021). Analysing underlying comorbidities, more subjects with a Charlson Comorbidity Index >1 were observed in the second wave, associated to a decrease in patients with a CCI=1. Triage evaluation showed a reduction of immediate/urgent codes in the second wave, with a higher percentage of patients assessed as delayed/expectant. The number of symptomatic patients shifted from 99.5% to 91% in October-November (p<0.001) and symptoms were milder. Many cases in the first wave presented not-pathological LUS and chest CT, while a higher number of positive findings was recorded in the second. Contrarily, chest X-Ray showed an increase in negative findings in the second period. Apart from a higher CRP value in the second wave, no substantial differences emerged in laboratory values. The necessity of respiratory support went through a reduction, shifting from 50.9% to 40.9% (p=0.013). Discharge rate rose in the second wave (32.6% vs 46.5%, p<0.001), hospitalizations decreased (65.6% vs 52%, p<0.001), registering more admissions in internal medicine wards along with a decline in admissions in ICU or sub-intensive care wards. Despite the trend did not reach significance, a lowering of hospital mortality and length of stay was observed as well. Multivariate analysis showed that age and CCI increased the risk of hospital admission (OR 1.08 [1.07-1.10] and 1.55 [1.29-1.91]), while accessing the ED in the second wave was a protective factor (OR 0.6[0.39-0.91]). Further, elderly patients, with a CCI>=1 and immediate/urgent at triage assessment had a higher risk of hospital death. Conclusions: The study evidenced that population accessing the ED during the first and the second pandemic periods differed in demographical and clinical characteristics as well as short and mid-term outcomes. Patients admitted in the second wave were younger with a milder illness; if hospitalized required fewer days to recover, had lower mortality rates and treatments were less intensive.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.14240/129881