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Pressure on the Health-Care System and Intensive Care Utilization During the COVID-19 Outbreak in the Lombardy Region of Italy: A Retrospective Observational Study in 43,538 Hospitalized Patients.
Am J Epidemiol ; 191(1): 137-146, 2022 01 01.
Article in English | MEDLINE | ID: covidwho-1621545
ABSTRACT
During the spring of 2020, the coronavirus disease 2019 (COVID-19) epidemic caused an unprecedented demand for intensive-care resources in the Lombardy region of Italy. Using data on 43,538 hospitalized patients admitted between February 21 and July 12, 2020, we evaluated variations in intensive care unit (ICU) admissions and mortality over the course of 3 periods the early phase of the pandemic (February 21-March 13), the period of highest pressure on the health-care system (March 14-April 25, when numbers of COVID-19 patients exceeded prepandemic ICU bed capacity), and the declining phase (April 26-July 12). Compared with the early phase, patients aged 70 years or more were less often admitted to an ICU during the period of highest pressure on the health-care system (odds ratio (OR) = 0.47, 95% confidence interval (CI) 0.41, 0.54), with longer ICU delays (incidence rate ratio = 1.82, 95% CI 1.52, 2.18) and lower chances of dying in the ICU (OR = 0.47, 95% CI 0.34, 0.64). Patients under 56 years of age had more limited changes in the probability of (OR = 0.65, 95% CI 0.56, 0.76) and delay to (incidence rate ratio = 1.16, 95% CI 0.95, 1.42) ICU admission and increased mortality (OR = 1.43, 95% CI 1.00, 2.07). In the declining phase, all quantities decreased for all age groups. These patterns may suggest that limited health-care resources during the peak phase of the epidemic in Lombardy forced a shift in ICU admission criteria to prioritize patients with higher chances of survival.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Delivery of Health Care / COVID-19 / Intensive Care Units Type of study: Etiology study / Observational study / Randomized controlled trials / Risk factors Limits: Adult / Aged / Humans / Middle aged Country/Region as subject: Europa Language: English Journal: Am J Epidemiol Year: 2022 Document Type: Article Affiliation country: Aje

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Delivery of Health Care / COVID-19 / Intensive Care Units Type of study: Etiology study / Observational study / Randomized controlled trials / Risk factors Limits: Adult / Aged / Humans / Middle aged Country/Region as subject: Europa Language: English Journal: Am J Epidemiol Year: 2022 Document Type: Article Affiliation country: Aje