ABSTRACT
BACKGROUND: Elevated D-dimer levels have been observed in COVID-19 and are of prognostic value, but have not been compared to an appropriate control group. METHODS: Observational cohort study including emergency patients with suspected or confirmed COVID-19. Logistic regression defined the association of D-dimer levels, COVID-19 positivity, age, and gender with 30-day-mortality. RESULTS: 953 consecutive patients (median age 58, 43% women) presented with suspected COVID-19: 12 (7.4%) patients with confirmed SARS-CoV-2-infection died, compared with 28 (3.5%) patients without SARS-CoV-2-infection. Overall, most (56%) patients had elevated D-dimer levels (>=0.5mg/l). Age (OR 1.07, CI 1.05-1.10), D-dimer levels >=0.5mg/l (OR 2.44, CI 0.98-7.39), and COVID-19 (OR 2.79, CI 1.28-5.80) were associated with 30-day-mortality. CONCLUSION: D-dimer levels are effective prognosticators in both patient groups.
ABSTRACT
Introduction: The assessment of COVID-19 associated mortality is crucial to evaluate the impact of the pandemic and to assess the effectiveness of measures. Objectives: We aimed to investigate trends in COVID-19 related mortality over time in Switzerland, using data from the COVID-19 Hospitalbased Surveillance (CH-SUR) database. Methods: Considering four different time periods of COVID-19 epidemic, we calculated crude and adjusted mortality rates and performed competing risks survival analyses for all patients and for patients admitted to intensive care (ICU). Results: Overall, 16,967 COVID-19 related hospitalizations and 2,307 deaths of adult patients were recorded. Crude hospital mortality rates were 15.6% in the 1st and 14.4% in the 2nd wave;for ICU patients it was 24% and 31.3%, respectively. The overall adjusted risk of death was lower for hospitalised patients during the 2nd compared to the 1st wave (HR 0.75, 95% CI 0.73 - 0.77). In contrast, patients admitted to ICU as well as patients with invasive ventilation presented a higher risk of death during the 2nd wave (HR 1.62, 95% CI 1.54-1.70 and HR 2.10, 95% CI 1.99-2.20, respectively). Conclusion: Our findings may be explained by various changes in the COVID-19 patient management in Swiss hospitals, e.g. with the use of effective drugs against complications or with different guidelines for ICU admission and invasive ventilation use.
ABSTRACT
Introduction: Protecting healthcare workers (HCWs) from exposure to SARS-CoV-2 during patient care is central to managing the current pandemic. Higher levels of trust in personal protective equipment (PPE) and infection prevention and control (IPC) strategies have been previously related to lower levels of emotional exhaustion, yet little is known on how to achieve such a perception of safety. Objectives: We sought to identify institutional actions, strategies and policies related to HCW's safety perception during the early phase of the pandemic at a tertiary care center in Switzerland by interviewing HCWs from different clinics, professions and positions. Methods: For this qualitative study, 36 face-to-face semi-structured interviews were performed. Interviews were based on a guide addressing the perception of institutional strategies and policies during the first phase of the pandemic in March 2020. The participants included doctors (n = 19) and nurses (n = 17) in senior and non-senior positions from eight clinics in the University Hospital Basel, Switzerland, all involved in patient care. All interviews were audio-recorded and transcribed verbatim. Data were analyzed using qualitative content analysis and organized using MAXQDA (VERBI Software GmbH, Berlin). Results: Five recurring themes were identified to affect perceived safety of HCWs during the SARS-CoV-2 pandemic: 1) transparency and clarity of information, 2) communication on the availability of PPE (with provision of information alone increasing the feeling of safety even if supplies of PPE were reported to be low), 3) uniformity and consistency of guidelines, 4) digital resources to support face-to-face teaching (with personal information transfer still being considered superior in terms of strengthening safety perception) and 5) support and appreciation for the work performed. Conclusion: This study identifies institutional policies and actions, the most important of which being transparent communication, influencing HCW's safety perception during the first wave of the COVID-19 pandemic. Such knowledge reveals potential areas of action critical to improving preparedness and management in hospitals faced with an infectious disease threat.