ABSTRACT
COVID-19 vaccination impact on hospital outcome metrics among patients hospitalized with COVID-19 is not well known. We evaluated if covid-19 vaccination was associated with better hospital outcomes such as in-hospital mortality, overall length of stay, and home discharge. This retrospective study analyzed data from the electronic health records of 29,732 patients admitted with COVID-19 with or without vaccination (21,525 unvaccinated and 8207 vaccinated) from January to December 2021. The association of COVID-19 vaccination status with overall length of hospitalization, in-hospital mortality rate, home discharge after hospitalization was investigated using a multivariate logistic regression and a generalized linear model. The mean age of all groups was 58.16 ± 17.39 years. The unvaccinated group was younger (54.95 ± 16.75) and had less comorbidities compared to the vaccinated group. Patients that had received COVID-19 vaccination exhibited decreased in-hospital mortality (OR 0.666, 95 % CI 0.580-0.764), decreased length of stay (-2.13 days, CI 2.73-1.55 days), and increased rate of home discharge (OR 1.168, CI 1.037-1.315). Older age and cerebrovascular accident diagnosis at admission demonstrated a negative effect on hospital outcomes with decreased home discharge (OR 0.950 per 1 year, CI 0.946-0.953 and OR 0.415, CI 0.202-0.854) and increased inhospital mortality (OR 1.04 per 1 year, CI 1.036-1.045 and OR 3.005, CI 1.961-4.604). This study shows the additional positive impact of COVID-19 vaccination has not just on in-hospital mortality but also in reducing overall length of stay and improved hospital outcome metrics including increasing likelihood of home discharge after hospitalization.
ABSTRACT
OBJECTIVES: The Coronavirus Disease 2019 pandemic has affected the health care system significantly. We compare 2019 to 2020 to evaluate how trauma encounters has changed during the pandemic. METHODS: Retrospective analysis using a large US health care system to compare trauma demographics, volumes, mechanisms of injury, and outcomes. Statistical analysis was used to evaluate for significant differences comparing 2019 to 2020. RESULTS: Data was collected from 88 hospitals across 18 states. 169 892 patients were included in the study. There were 6.3% fewer trauma patient encounters in 2020 compared to 2019. Mechanism of injury was significantly different between 2019 and 2020 with less blunt injuries (89.64% vs. 88.39%, P < .001), more burn injuries (1.84% vs. 2.00%, P = .021), and more penetrating injuries (8.58% vs. 9.75%, P < .001). Compared to 2019, patients in 2020 had higher mortality (2.62% vs. 2.88%, P < .001), and longer hospital LOS (3.92 ± 6.90 vs. 4.06 ± 6.56, P < .001). CONCLUSION: The COVID-19 pandemic has significantly affected trauma patient demographics, LOS, mechanism of injury, and mortality.
ABSTRACT
To highlight opportunities to decrease adverse outcomes in the acute management of COVID-19 infection. Descriptive single-subject study. Inpatient/Acute rehabilitation. A 47-year-old female with Ventilator-Dependent Respiratory Failure (VDRF) secondary to COVID-19. In the ED, Patient was started on antibiotics (azithromycin, ceftriaxone), nebulizer treatments, intravenous fluids, and intramuscular corticosteroids (methylprednisolone). On hospital admission, she was initiated on antiviral Remdesivir and received 1 unit of convalescent plasma. Self-proning was encouraged, yet Patient required progressive increase in oxygen (O2) supplementation. She was intubated from Hospital Day (HD) 4 to 7. Wound care assessments began on HD10;wounds to low back and bilateral buttocks were noted. By HD15, O2 requirements were further weaned and Patient was transferred to Acute Inpatient Rehab. On Rehab admission, Patient had Leukocytosis and wounds noted as "Unstageable". Antibiotic coverage was increased (Cefepime). By HD28/ Rehab Day (RD) 13, wound culture was positive, and antibiotic regimen was further supplemented (Metronidazole, Fluconazole, Daptomycin). MRI thoracic spine and pelvis demonstrated "necrotizing soft-tissue infection". Surgical debridement occurred HD31/RD16 with subsequent anemia, requiring transfusion. She underwent additional surgical debridement on HD38/RD23 and was returned to the Acute floors. She was discharged to home with outpatient wound care on HD53. Wound size (area). Wound size: Hospital Day (HD) 10: 284.39cm2;HD16/Rehab Day (RD) 1: 698.6cm2;HD34/RD19: 265.66;HD39:747.72cm2;HD51: Area = 992.80cm2. ∆Area, Pre-Rehab (HD16-HD10): (+) 414.2cm2;∆Area, Rehab (HD34/RD19-HD16/RD1): (-) 439.94;∆Area, Post-Rehab (HD51-HD34): (+) 727.14. Inpatient Rehabilitation practices may help ameliorate pressure injury in cases of VDRF secondary to COVID-19 infection. Further study is warranted on the potential integration of such practices in this patient population, as a preventative measure in the Acute and/or Critical care settings. Affiliation: HCA Healthcare (MountainView Hospital) Disclaimer: This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the authors and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.