Higher clinical acuity and 7-day hospital mortality in non-COVID-19 acute medical admissions: prospective observational study

Abstract

OBJECTIVES: To understand the effect of COVID-19 lockdown measures on severity of illness and mortality in non-COVID-19 acute medical admissions.

DESIGN: A prospective observational study.

SETTING: 3 large acute medical receiving units in NHS Lothian, Scotland.

PARTICIPANTS: Non-COVID-19 acute admissions (n=1682) were examined over the first 31 days after the implementation of the COVID-19 lockdown policy in the UK on 23 March 2019. Patients admitted over a matched interval in the previous 5 years were used as a comparator cohort (n=14 954).

MAIN OUTCOME MEASURES: Patient demography, biochemical markers of clinical acuity and 7-day hospital inpatient mortality.

RESULTS: Non-COVID-19 acute medical admissions reduced by 44.9% across all three sites in comparison with the mean of the preceding 5 years (p<0.001). Patients arriving during this period were more likely to be male, of younger age and to arrive by emergency ambulance transport. Non-COVID-19 admissions during lockdown had a greater incidence of acute kidney injury, lactic acidaemia and an increased risk of hospital death within 7 days (4.2% vs 2.5%), which persisted after adjustment for confounders (OR 1.87, 95% CI 1.43 to 2.41, p<0.001).

CONCLUSIONS: These data demonstrate a significant reduction in non-COVID-19 acute medical admissions during the early weeks of lockdown. Patients admitted during this period were of higher clinical acuity with a higher incidence of early inpatient mortality.

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© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ. This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained. https://bmj.com/coronavirus/usage

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DOI

http://dx.doi.org/10.1136/emermed-2020-210030

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https://www.research.ed.ac.uk/portal/en/publications/higher-clinical-acuity-and-7day-hospital-mortality-in-noncovid19-acute-medical-admissions(c5adfacd-89a4-4f29-9770-711adc84e9c1).html