How Do COVID-19 Inpatients in the Denver Metropolitan Area Measure Up?

BACKGROUND: Inpatient data for COVID-19 (SARS-CoV-2) afflicted inpatients remain sparse. Data are needed to create accurate projections for resource consumption as the pandemic continues. Published reports of inpatient data have come from China, Italy, Singapore, and both the East and West coasts of the United States. OBJECTIVE: The objective is to present our inpatient experience with COVID-19. Design, Setting, and Participants. This is a retrospective study of 681 patients with laboratory-confirmed COVID-19 from six hospitals in the Denver metropolitan area admitted between February 18 and April 30, 2020. Clinical outcomes of patients discharged or expired by April 30, 2020, were analyzed. Main Outcomes. We compiled patient demographics, length of stay, number of patients transferred to or admitted to the ICU, ICU length of stay, mechanical ventilation requirements, and mortality rates. RESULTS: Of the 890 patients with laboratory-confirmed COVID-19, 681 had discharged and were included in this analysis. We observed 100% survival of the 0-18 age group (n = 2), 97% survival of the 19-30 age group, 95% survival of the 31-64 age group, 79% survival of the 65-84 age group, and 75% survival of the 85 and older age group. Our total inpatient mortality was 13% (91 patients), rising to 29% (59 patients) for those requiring ICU care. CONCLUSIONS: Compared to similar reports from other metropolitan areas, our analysis of discharged or expired COVID-19 patients from six major hospitals in the Denver metropolitan area revealed a lower mortality. This includes the subset of patients admitted to the ICU regardless of the need for intubation. A lower ICU length of stay was also observed.

A Case of a 34-Year-Old Female with Acute Hypoxemic Respiratory Failure and Proximal Muscle Weakness.

Wound associated botulism is an unusual presentation. Early detection of this potentially life-threatening illness can significantly shorten length of hospital stay and improve prognosis. We present a case of a 34-year-old female with a history of heroin abuse who presented to the ED with acute respiratory failure, diplopia, and proximal muscle weakness. There was early concern for wound botulism as the instigating process. After discussion with the CDC, she was given equine serum heptavalent botulism antitoxin. Laboratory analysis later confirmed our suspicion. Symptoms improved and the patient was liberated from mechanical ventilation on day 14 and discharged from the hospital on day 23.

Organizing pneumonia: prognostic implication of high-resolution computed tomography features.

PURPOSE: Most patients with biopsy-proven organizing pneumonia (OP) show complete resolution of radiographic lesions with treatment, but some patients do not respond to treatment and progress to pulmonary fibrosis. The authors investigated the prognostic implication of high-resolution computed tomography (CT) features in this condition. METHOD: We reviewed the high-resolution CT findings of 26 patients diagnosed with OP by histopathology, who had radiographic follow-up for a median of 44 weeks after treatment. We scored the presence and extent of each pretreatment high-resolution CT finding (ground-glass opacity, consolidation, nodules, reticular opacity, and honeycombing). The predominant pattern and distribution of the lesions were recorded. Follow-up radiographs were used to determine whether the parenchymal abnormalities had regressed or progressed in response to treatment. RESULTS: Of the 26 patients, 9 had persistent or progressive parenchymal abnormalities at follow-up (group 1), whereas 17 had complete or partial resolution of abnormalities (group 2). Consolidation was present on the initial CT scan in 14 (82%) of the 17 patients in group 2, but in only 2 of the 9 patients in group 1 (P = 0.009). None of the 6 patients who had reticular abnormality as the predominant pattern on initial CT showed complete resolution on follow-up imaging (P = 0.02). CONCLUSION: In patients with OP, the CT finding of consolidation is associated with partial or complete resolution, whereas reticular opacity is associated with persistent or progressive disease.