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Predictors of clinical deterioration in patients with suspected COVID-19 managed in a virtual hospital' setting: A cohort study

Predictors of clinical deterioration in patients with suspected COVID-19 managed in a virtual hospital' setting: A cohort study
Predictors of clinical deterioration in patients with suspected COVID-19 managed in a virtual hospital' setting: A cohort study

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 OUTCOME MEASURE: 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.

COVID-19, epidemiology, general medicine (see internal medicine), infectious diseases, Humans, Middle Aged, Risk Factors, Male, COVID-19/diagnosis, Clinical Deterioration, Hospitals, Adult, Female, Aged, Remote Consultation, Cohort Studies
2044-6055
Francis, Nick A.
9b610883-605c-4fee-871d-defaa86ccf8e
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
Knight, Matthew
40d40a23-8b20-4266-bf43-eec396e2cff0
Vancheeswaran, Rama
04b638c8-0a0e-4591-8607-3d823c3bc1e1
Oliver, Charles
ad476b8e-ac4c-4822-abd1-78ffe387a484
Willcox, Merlin
dad5b622-9ac2-417d-9b2e-aad41b64ffea
Barlow, Andrew
37493a01-e4b7-48f1-91df-9dbcace3af15
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Francis, Nick A.
9b610883-605c-4fee-871d-defaa86ccf8e
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
Knight, Matthew
40d40a23-8b20-4266-bf43-eec396e2cff0
Vancheeswaran, Rama
04b638c8-0a0e-4591-8607-3d823c3bc1e1
Oliver, Charles
ad476b8e-ac4c-4822-abd1-78ffe387a484
Willcox, Merlin
dad5b622-9ac2-417d-9b2e-aad41b64ffea
Barlow, Andrew
37493a01-e4b7-48f1-91df-9dbcace3af15
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99

Francis, Nick A., Stuart, Beth, Knight, Matthew, Vancheeswaran, Rama, Oliver, Charles, Willcox, Merlin, Barlow, Andrew and Moore, Michael (2021) Predictors of clinical deterioration in patients with suspected COVID-19 managed in a virtual hospital' setting: A cohort study. BMJ Open, 11 (3), [e045356]. (doi:10.1136/bmjopen-2020-045356).

Record type: Article

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 OUTCOME MEASURE: 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.

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More information

Accepted/In Press date: 10 March 2021
Published date: 23 March 2021
Keywords: COVID-19, epidemiology, general medicine (see internal medicine), infectious diseases, Humans, Middle Aged, Risk Factors, Male, COVID-19/diagnosis, Clinical Deterioration, Hospitals, Adult, Female, Aged, Remote Consultation, Cohort Studies

Identifiers

Local EPrints ID: 449167
URI: http://eprints.soton.ac.uk/id/eprint/449167
ISSN: 2044-6055
PURE UUID: fb3cd3f3-c16c-411a-b95f-f126769deb95
ORCID for Nick A. Francis: ORCID iD orcid.org/0000-0001-8939-7312
ORCID for Beth Stuart: ORCID iD orcid.org/0000-0001-5432-7437
ORCID for Merlin Willcox: ORCID iD orcid.org/0000-0002-5227-3444
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509

Catalogue record

Date deposited: 18 May 2021 16:33
Last modified: 26 Nov 2021 03:20

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Contributors

Author: Nick A. Francis ORCID iD
Author: Beth Stuart ORCID iD
Author: Matthew Knight
Author: Rama Vancheeswaran
Author: Charles Oliver
Author: Merlin Willcox ORCID iD
Author: Andrew Barlow
Author: Michael Moore ORCID iD

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