Adam J. Singer, MD, Eric J. Morley, MD, Kristen Meyers, MEng, Rafael Fernandes,
BS, Alison L. Rowe, RN, Peter Viccellio, MD, Henry C. Thode, PhD, AlexanderBracey, MD, Mark C. Henry, MD
Most COVID-19 reports have focused on SARS-CoV-2 positive patients. However, at the time of initial presentation, most patients’ viral status is unknown. Determination of factors that predict initial and subsequent need for intensive care (ICU) and invasive mechanical ventilation (IMV) are critical for resource planning and allocation. We describe our experience with 4,404 persons under investigation (PUI) and explore predictors of ICU care and IMV at a NY COVID-19 epicenter.
We conducted a retrospective COHORT of all persons under investigation (PUI) presenting to a large academic medical center emergency department (ED) in NYS with symptoms suggestive of COVID-19. The association between patient predictor variables and SARS-CoV-2 status, intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), and mortality were explored with univariate and multivariate analyses.
Between March 12-April 14, 2020 we saw 4,404 PUI patients of whom 68% were discharged home, 29% were admitted to a regular floor and 3% to an ICU. 1,651 of 3,369 patients tested were SARS-CoV-2 positive to date. Of regular floor admits, 13% were subsequently upgraded to the ICU after a median (IQR) of 62 (28-106) hrs. 50 patients required IMV in the ED, 4 required prehospital IMV, and another 167 subsequently required IMV in a median (IQR) of 60 (26-99) hours after admission. Testing positive for SARS-CoV-2 and lower oxygen saturations were associated with need for ICU, IMV and death. High respiratory rates were associated with the need for ICU care.
PUI for COVID-19 contribute significantly to the healthcare burden beyond those ruling in for SARS-CoV-2. For every 100 admitted PUI, 9 will require ICU and/or IMV upon arrival and another 12 within 2-3 days of hospital admission, especially PUIs with lower oxygen saturations and positive SARS-CoV-2 swabs. This information should help hospitals stay ahead of the pandemic curve.