TY  - BOOK
AU  - Alnababteh, Muhtadi
AU  - Alunikummannil, Jojo
AU  - Hashmi, Muhammad Daniyal
AU  - Oweis, Emil S
AU  - Shorr, Andrew F
AU  - Vedantam, Karthik
TI  - Assessing the need for transfer to the intensive care unit for Coronavirus-19 disease: Epidemiology and risk factors
SN  - 0954-6111
PY  - 2020///
KW  - *Intensive Care Units/sn [Statistics & Numerical Data]
KW  - *Patient Transfer/og [Organization & Administration]
KW  - Comorbidity
KW  - Female
KW  - Ferritins/bl [Blood]
KW  - Hospitalization
KW  - Humans
KW  - Lymphocyte Count/mt [Methods]
KW  - Male
KW  - Middle Aged
KW  - Pandemics/sn [Statistics & Numerical Data]
KW  - Research Design/sn [Statistics & Numerical Data]
KW  - Research Design/st [Standards]
KW  - Respiratory Insufficiency/ep [Epidemiology]
KW  - Respiratory Insufficiency/et [Etiology]
KW  - Retrospective Studies
KW  - Risk Assessment
KW  - Risk Factors
KW  - Time Factors
KW  - MedStar Washington Hospital Center
KW  - Medicine/General Internal Medicine
KW  - Medicine/Pulmonary-Critical Care
KW  - Journal Article
N2  - BACKGROUND: Although many patients with coronavirus disease 2019 (Covid-19) require direct admission to the intensive care unit (ICU), some are sent after admission. Clinicians require an understanding of this phenomenon and various risk stratification approaches for recognizing these subjects; CONCLUSION: Covid-19 patients admitted to general wards face a significant risk for deterioration necessitating ICU admission and respiratory failure can occur late in this disease. Neither baseline clinical factors nor the CURB-65 score perform well as screening tests to categorize these subjects as likely to progress to ICU care. Copyright (c) 2020. Published by Elsevier Ltd; METHODS: We examined all Covid-19 patients sent initially to a ward who subsequently required care in the ICU. We examined the timing transfer and attempted to develop a risk score based on baseline variables to predict progressive disease. We evaluated the utility of the CURB-65 score at identifying the need for ICU transfer; RESULTS: The cohort included 245 subjects (mean age 59.0 +/- 14.2 years, 61.2% male) and 20% were eventually sent to the ICU. The median time to transfer was 2.5 days. Approximately 1/3rd of patients were not moved until day 4 or later and the main reason for transfer (79.2%) was worsening respiratory failure. A baseline absolute lymphocyte count (ALC) of <=0.8 103/ml and a serum ferritin >=1000 ng/ml were independently associated with ICU transfer. Co-morbid illnesses did not correlate with eventual ICU care. Neither a risk score based on a low ALC and/or high ferritin nor the CURB-65 score performed well at predicting need for transfer
UR  - https://dx.doi.org/10.1016/j.rmed.2020.106203
UR  - https://dx.doi.org/10.1016/j.rmed.2020.106203
ER  -