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Objectives <p>The scarcity of intensive care unit (ICU) beds during the COVID-19 pandemic has led to a large number of national and international guidelines for the triage of ICU admission. Regional variation in medical decision making might affect ICU triage decisions. We investigate whether regional differences in ICU admission, as surrogate for triage decisions, affect in-hospital mortality in COVID-19 patients.</p> Methods <p>The COMET study is a multicenter, observational cohort study, including adult patients hospitalized for COVID-19 between March 2020– July 2020. Patients’ characteristics, prescribed medication, clinical characteristics, and CFS were collected. Patients from 11 European countries were included and these countries were categorized into two regions: north and south. The effects of region on ICU admission and in-hospital mortality were assessed using logistic regression analyses stratified for frailty.</p> Results <p>Frail patients had a higher risk for ICU admission in southern compared to northern countries (OR: 1.64; 95%CI: 1.10–2.46), whereas fit patients had a similar risk for ICU admission in southern compared to northern countries (OR: 0.75; 95%CI: 0.55–1.01). There was no difference in in-hospital mortality between northern and southern countries for fit and frail patients (respectively OR: 0.82; 95% CI 0.52–1.29, and OR: 1.11; 95% CI: 0.74–1.66).</p> Conclusion <p>Our study shows that, despite variation in rates of ICU admission between northern and southern countries for frail patients, no difference in in-hospital mortality was observed. This might help optimize prioritization of resources in a pandemic setting while offering options for palliative care instead of ICU admission.</p>

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Regional differences in triage decisions affect hospital mortality among frail COVID-19 patients in the COvid MEdicaTion study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年2月4日

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  • Julia Minnema,
  • Roos Sablerolles,
  • Janneke van Kempen,
  • Hugo van der Kuy,
  • Harmke Polinder-Bos,
  • Bob van de Loo,
  • Jorie Versmissen,
  • Miriam L. Haaksma,
  • Melvin Lafeber,
  • Miriam C. Faes,
  • Julia Minnema,
  • Roos Sablerolles,
  • Janneke van Kempen,
  • Hugo van der Kuy,
  • Harmke Polinder-Bos,
  • Bob van de Loo,
  • Jorie Versmissen,
  • Melvin Lafeber,
  • Miriam C. Faes,
  • Ingrid van Haelst,
  • Louise Andrews,
  • Marleen Kemper,
  • Roland van den Berg,
  • Elise Slob,
  • Firdaouss Boutkourt,
  • Erik van Kan,
  • Ronald Van Etten,
  • Mariette Kappers,
  • Peter van Wijngaarden,
  • Anja Vos,
  • Linda Hendriksen,
  • Hugo de Wit,
  • Loes Visser,
  • Judith Derijks,
  • Doris Haider,
  • Nikolaus Lindner,
  • Monika Schwap,
  • Jos Tournoy,
  • Lorenz Van der Linden,
  • Morten Baltzer Houlind,
  • Roberto Tessari,
  • Paola Chessa,
  • Marco Gambera,
  • Isabella Martignoni,
  • Laura Agnoletto,
  • Margarida Falcao,
  • Helena Farinha,
  • Dina Mendes,
  • Ines Carmo,
  • Joana Soares,
  • Fatima Falcao,
  • Mariana Solano,
  • Erica Viegas,
  • Marta Miarons,
  • Maria Queralt Gorgas,
  • Cristina García Yubero,
  • Kim Blum,
  • Kim Keijzers,
  • Silke Lim

摘要

Objectives

The scarcity of intensive care unit (ICU) beds during the COVID-19 pandemic has led to a large number of national and international guidelines for the triage of ICU admission. Regional variation in medical decision making might affect ICU triage decisions. We investigate whether regional differences in ICU admission, as surrogate for triage decisions, affect in-hospital mortality in COVID-19 patients.

Methods

The COMET study is a multicenter, observational cohort study, including adult patients hospitalized for COVID-19 between March 2020– July 2020. Patients’ characteristics, prescribed medication, clinical characteristics, and CFS were collected. Patients from 11 European countries were included and these countries were categorized into two regions: north and south. The effects of region on ICU admission and in-hospital mortality were assessed using logistic regression analyses stratified for frailty.

Results

Frail patients had a higher risk for ICU admission in southern compared to northern countries (OR: 1.64; 95%CI: 1.10–2.46), whereas fit patients had a similar risk for ICU admission in southern compared to northern countries (OR: 0.75; 95%CI: 0.55–1.01). There was no difference in in-hospital mortality between northern and southern countries for fit and frail patients (respectively OR: 0.82; 95% CI 0.52–1.29, and OR: 1.11; 95% CI: 0.74–1.66).

Conclusion

Our study shows that, despite variation in rates of ICU admission between northern and southern countries for frail patients, no difference in in-hospital mortality was observed. This might help optimize prioritization of resources in a pandemic setting while offering options for palliative care instead of ICU admission.