Predictors of clinical deterioration in patients with suspected COVID-19 managed in a 'virtual hospital' setting: a cohort study.
BMJ Open
; 11(3): e045356, 2021 03 23.
Article
in English
| MEDLINE | ID: covidwho-1148168
ABSTRACT
OBJECTIVE:
Identify predictors of clinical deterioration in a virtual hospital (VH) setting for COVID-19.DESIGN:
Real-world prospective observational study.SETTING:
VH remote assessment service in West Hertfordshire NHS Trust, UK.PARTICIPANTS:
Patients with suspected COVID-19 illness enrolled directly from the community (postaccident and emergency (A&E) or medical intake assessment) or postinpatient admission. MAIN OUTCOMEMEASURE:
Death or (re-)admission to inpatient hospital care during VH follow-up and for 2 weeks post-VH discharge.RESULTS:
900 patients with a clinical diagnosis of COVID-19 (455 referred from A&E or medical intake and 445 postinpatient) were included in the analysis. 76 (8.4%) of these experienced clinical deterioration (15 deaths in admitted patients, 3 deaths in patients not admitted and 58 additional inpatient admissions). Predictors of clinical deterioration were increase in age (OR 1.04 (95% CI 1.02 to 1.06) per year of age), history of cancer (OR 2.87 (95% CI 1.41 to 5.82)), history of mental health problems (OR 1.76 (95% CI 1.02 to 3.04)), severely impaired renal function (OR for eGFR <30=9.09 (95% CI 2.01 to 41.09)) and having a positive SARS-CoV-2 PCR result (OR 2.0 (95% CI 1.11 to 3.60)).CONCLUSIONS:
These predictors may help direct intensity of monitoring for patients with suspected or confirmed COVID-19 who are being remotely monitored by primary or secondary care services. Further research is needed to confirm our findings and identify the reasons for increased risk of clinical deterioration associated with cancer and mental health problems.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Remote Consultation
/
Clinical Deterioration
/
COVID-19
Type of study:
Cohort study
/
Diagnostic study
/
Observational study
/
Prognostic study
Topics:
Long Covid
Limits:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
English
Journal:
BMJ Open
Year:
2021
Document Type:
Article
Affiliation country:
Bmjopen-2020-045356
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