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 f...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2021-03-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/11/3/e045356.full |
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| author | Beth Stuart Nick A Francis Michael Moore Merlin Willcox Matthew Knight Rama Vancheeswaran Andrew Barlow Charles Oliver |
| author_facet | Beth Stuart Nick A Francis Michael Moore Merlin Willcox Matthew Knight Rama Vancheeswaran Andrew Barlow Charles Oliver |
| author_sort | Beth Stuart |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-115dda31ec944f5b8e2b865fd7496a81 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-115dda31ec944f5b8e2b865fd7496a812024-11-21T02:10:12ZengBMJ Publishing GroupBMJ Open2044-60552021-03-0111310.1136/bmjopen-2020-045356Predictors of clinical deterioration in patients with suspected COVID-19 managed in a ‘virtual hospital’ setting: a cohort studyBeth Stuart0Nick A Francis1Michael Moore2Merlin Willcox3Matthew Knight4Rama Vancheeswaran5Andrew Barlow6Charles Oliver71 School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UKprofessor and general practitionerPrimary Care Medical Group, University of Southampton Medical School, Southampton, UKPrimary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UKRespiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UKconsultant physicianWest Midlands Ambulance Service University NHS Foundation Trust, UK2Anaesthesia and Perioperative Medicine, University College London Hospital NHS Foundation Trust, London, UKObjective 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.https://bmjopen.bmj.com/content/11/3/e045356.full |
| spellingShingle | Beth Stuart Nick A Francis Michael Moore Merlin Willcox Matthew Knight Rama Vancheeswaran Andrew Barlow Charles Oliver Predictors of clinical deterioration in patients with suspected COVID-19 managed in a ‘virtual hospital’ setting: a cohort study BMJ Open |
| title | Predictors of clinical deterioration in patients with suspected COVID-19 managed in a ‘virtual hospital’ setting: a cohort study |
| title_full | Predictors of clinical deterioration in patients with suspected COVID-19 managed in a ‘virtual hospital’ setting: a cohort study |
| title_fullStr | Predictors of clinical deterioration in patients with suspected COVID-19 managed in a ‘virtual hospital’ setting: a cohort study |
| title_full_unstemmed | Predictors of clinical deterioration in patients with suspected COVID-19 managed in a ‘virtual hospital’ setting: a cohort study |
| title_short | Predictors of clinical deterioration in patients with suspected COVID-19 managed in a ‘virtual hospital’ setting: a cohort study |
| title_sort | predictors of clinical deterioration in patients with suspected covid 19 managed in a virtual hospital setting a cohort study |
| url | https://bmjopen.bmj.com/content/11/3/e045356.full |
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