RESUMO
Background: COVID-19 is associated with the development of life-threatening prothrombotic events, including pulmonary emboli (PE), for which the gold standard investigation is a CTPA. Aim(s): To assess the incidence of PE in our local high-dependency and ward-based COVID-19 ward and identify common indications for CTPA. Method(s): Data was collected retrospectively from inpatients admitted to our COVID-19 ward between August 1st to October 31st, 2021. Patient demographics, D-dimer values, oxygen requirements, and CTPA request indications and findings were analysed. Result(s): From a total of N=123 patients, N=45 (36.9%) had a CTPA, and N=4 (3.3% of all patients, 8.9% of CTPA requests) were positive for PE. N=44 (97.8%) CTPAs were requested to rule out a PE, with the main indications being a raised D-dimer (26.7%), hypotension (24.4%), persistent oxygen requirement (22.2%), and desaturation (22.2%). N=18 (40%) required non-invasive ventilation (NIV) at the time of CTPA request. The median time spent on therapeutic anticoagulation before a CTPA was 6 days (IQR 9). N=8 (17.7%) had bleeding complications from therapeutic anticoagulation. Conclusion(s): Our 3.3% incidence of PE is lower than the 11.7% average in a recent meta-analysis of ITU patients, consistent with studies showing that those with more severe COVID-19 have a higher incidence of PE (Tan, B.K. et al. Thorax 2021;76: 970-979). Our study was limited, as our patients could not have a CTPA whilst on NIV. They remained on therapeutic anticoagulation during this time, leading to potential false-negative results. Further studies are needed to estimate the incidence of PE and optimum duration of thromboprophylaxis in non-severe COVID-19 cases.
RESUMO
The world has been pushed to the edge of a precipice commonly been addressed to as Coronavirus S (SARS-CoV2), one of the world's most widespread viral pandemic in recent times. Many studies are underway and investigating the new role of existing drugs, exploring the safety and efficacy of recently developed vaccines, after getting detailed insights into the behavioural characteristics of SARS-CoV2. Presently supportive and symptomatic treatment, along with practices like disease surveil-lance, contact tracing, and early diagnosis may help control the future of COVID-19 outbreaks. An ef-fort has been made to compile the information about coronavirus;its clinical manifestations, differential diagnosis, preventive aspects, and therapeutic options as a review.Copyright © 2021 Bentham Science Publishers.
RESUMO
Background: With the second surge of the COVID-19 pandemic in the NY metropolitan area, inpatient hospital wards have again become occupied by those with severe disease. Many are older adults (OA) with baseline frailty and impaired function who originally resided in a skilled nursing facility (SNF) or sustained hospital- acquired disability (HAD) and now need nursing and rehabilitation before returning home. A significant number of these OA are medically stable but remain COVID-19 positive, preventing transfer to SNF. Academic medical systems have redeployed residents and fellows inpatient to cover COVID-19 patients. In an effort to prevent HAD and iatrogenic complications a large health system has taken the innovative step of designating one of its SNFs as a “COVIDPositive Only” facility. This presented an opportunity to develop a novel curricular experience for geriatric fellows and improve care of a vulnerable population. Methods: The Division of Geriatrics and Palliative Medicine (GAP) collaborated with administration in a clinical initiative to deploy geriatric fellows to assist in covering the facility. Results: Within seven days a schedule was developed spanning 3 months and a curriculum drafted. The facility medical director (GAP faculty) is the site rotation director. Fellows rotate in pairs for two-week blocks and observing ACGME and NYS work hour restrictions. Within the first week of deployment, the team admitted 97 patients to the 120-bed facility, an average of 13.9/day. 3.1% were transferred back to hospital within 6 days. 17.5% were COVID negative on admission and able to be discharged. 86% lived at home prior to index admission. Fellows and faculty meet weekly to review progress, revise curriculum and address issues. Fellows are gathering clinical metrics on this population, including change in COVID-19+ status, readmissions, and functional status as a clinical initiative/scholarly project. Conclusions: The COVID-19 pandemic has created a unique opportunity to develop a novel model of care within a geriatric fellowship program with implications for training, scholarship and public health policy. Data on curriculum innovation and patient outcomes will be presented.