Association of Intensive Care Unit Patient Load and Demand With Mortality Rates in US Department of Veterans Affairs Hospitals During the COVID-19 Pandemic

Although strain on hospital capacity has been associated with increased mortality in nonpandemic settings, studies are needed to examine the association between coronavirus disease 2019 (COVID-19) critical care capacity and mortality. To examine whether COVID-19 mortality was associated with COVID-1...

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Bibliographic Details
Published in:JAMA network open 2021-01, Vol.4 (1), p.e2034266-e2034266
Main Authors: Bravata, Dawn M, Perkins, Anthony J, Myers, Laura J, Arling, Greg, Zhang, Ying, Zillich, Alan J, Reese, Lindsey, Dysangco, Andrew, Agarwal, Rajiv, Myers, Jennifer, Austin, Charles, Sexson, Ali, Leonard, Samuel J, Dev, Sharmistha, Keyhani, Salomeh
Format: Article
Language:English
Subjects:
Cohort Studies
Coronaviruses
COVID-19
COVID-19 - mortality
Critical care
Critical Illness - mortality
Hospitals, Veterans - organization & administration
Humans
Intensive care
Intensive Care Units - organization & administration
Mortality
Online Only
Original Investigation
Pandemics
Patients
Public Health
United States
United States Department of Veterans Affairs
Veterans
Veterans - statistics & numerical data
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Summary:Although strain on hospital capacity has been associated with increased mortality in nonpandemic settings, studies are needed to examine the association between coronavirus disease 2019 (COVID-19) critical care capacity and mortality. To examine whether COVID-19 mortality was associated with COVID-19 intensive care unit (ICU) strain. This cohort study was conducted among veterans with COVID-19, as confirmed by polymerase chain reaction or antigen testing in the laboratory from March through August 2020, cared for at any Department of Veterans Affairs (VA) hospital with 10 or more patients with COVID-19 in the ICU. The follow-up period was through November 2020. Data were analyzed from March to November 2020. Receiving treatment for COVID-19 in the ICU during a period of increased COVID-19 ICU load, with load defined as mean number of patients with COVID-19 in the ICU during the patient's hospital stay divided by the number of ICU beds at that facility, or increased COVID-19 ICU demand, with demand defined as mean number of patients with COVID-19 in the ICU during the patient's stay divided by the maximum number of patients with COVID-19 in the ICU. All-cause mortality was recorded through 30 days after discharge from the hospital. Among 8516 patients with COVID-19 admitted to 88 VA hospitals, 8014 (94.1%) were men and mean (SD) age was 67.9 (14.2) years. Mortality varied over time, with 218 of 954 patients (22.9%) dying in March, 399 of 1594 patients (25.0%) dying in April, 143 of 920 patients (15.5%) dying in May, 179 of 1314 patients (13.6%) dying in June, 297 of 2373 patients (12.5%) dying in July, and 174 of 1361 (12.8%) patients dying in August (P 
ISSN:2574-3805
2574-3805
DOI:10.1001/jamanetworkopen.2020.34266