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Pandemi öncesi ve pandemi döneminde acil servisten iç hastalıkları yoğun bakım ünitesine yatan COVID-19 dışı kritik hastaların karşılaştırılması

Year 2024, Volume: 63 Issue: 1, 106 - 114, 19.03.2024

Şükriye Miray Kılınçer Bozgül , İlkçe Akgün Kurtulmuş , Figen Yargucu , Mümtaz Yilmaz , Funda Karbek Akarca , Deniz Can Aydogan , Barış Özkılıç , Karya İslamoğlu , Güneş Ak , Fatma Feriha Çilli , Devrim Bozkurt

https://doi.org/10.19161/etd.1345563

Abstract

Amaç: COVID-19 pandemisi boyunca birçok yoğun bakım ünitesi yatağı kritik COVID-19 hastaları için ayrılmıştır. Ancak COVID-19 dışı kritik hastalar için yoğun bakım ihtiyacı devam etmektedir. Bu çalışmada pandemic öncesi ve pandemic dönemi boyunca acil servisten iç hastalıkları yoğun bakım ünitesine yatan COVID-19 dışı kritik hastaların karşılaştırılması amaçlanmıştır.
Gereç ve Yöntem: Acil servisten iç hastalıkları yoğun bakım ünitesine yatırılan hastalar pandemi öncesi (Mart 2018-Mart 2020) ve pandemi boyunca (Mart 2020-Mart 2022) olarak gruplanıp hasta yatış sayısı, demografik özellikler, yoğun bakım yatış süresi ve mortalite oranı açısından retrospektif olarak karşılaştırıldı.
Bulgular: Çalışma dönemi boyunca cerrahi neden dışı acil servis hasta başvuru sayısı 579.657 olup bu hastaların %63.33’ü pandemic öncesi, %36.67’si pandemic dönemi boyunca başvurmuştur. İç hastalıkları yoğun bakım ünitesine yatan ve çalışmaya dahil edilen hasta sayısı pandemi öncesinde 493 ve pandemi döneminde 460’tır. Medyan yaş, pandemi öncesi dönemindeki hastalarda 61 (30), pandemi döneminde ise 64 (26.8) olarak saptandı, p=0.022. Komorbiditeler açısından anlamlı fark saptanmadı. Başlıca yatış nedeni benzer olup sepsisin önde gelen yatış sebebi olduğu görüldü. Yoğun bakımda akut böbrek yetmezliği görülme sıklığı pandemi döneminde anlamlı yüksek saptandı. Yoğun bakımda kalış süresi iki grupta benzer saptandı. Mortalite pandemi öncesinde %25.2 ve pandemi döneminde %24.3 saptandı, p=0.760.
Sonuç: Acil servis başvuruları azalmasına rağmen COVID-19 dışı iç hastalıkları yoğun bakım hasta yatış sayısı azalmamıştır. Bu durum pandemi döneminde sağlık hizmetlerinin aksamaması için yoğun bakım alanlarının COVID-19 dışı nedenlerle yatış için de organize edilmesinin önemini ortaya koymaktadır.

Keywords

yoğun bakım ünitesi mortalite pandemi COVID-19

References

  • Santi L, Golinelli D, Tampieri A, et al. Non-COVID-19 patients in times of pandemic: Emergency department visits, hospitalizations and cause-specific mortality in Northern Italy. PLoS One 2021;16(3):e0248995.
  • Jeffery MM, D'Onofrio G, Paek H, et al. Trends in Emergency Department Visits and Hospital Admissions in Health Care Systems in 5 States in the First Months of the COVID-19 Pandemic in the US. JAMA Intern Med 2020;180(10):1328-33.
  • Van Damme W, Dahake R, Delamou A, et al. The COVID-19 pandemic: diverse contexts; different epidemics how and why? BMJ Glob Health 2020;5(7):e003098.
  • Tartari F, Guglielmo A, Fuligni F, Pileri A. Changes in emergency service access after spread of COVID-19 across Italy. J Eur Acad Dermatol Venereol 2020;34(8):350-51.
  • Zampieri FG, Bastos LSL, Soares M, Salluh JI, Bozza FA. The association of the COVID-19 pandemic and short-term outcomes of non-COVID-19 critically ill patients: an observational cohort study in Brazilian ICUs. Intensive Care Med 2021;47(12):1440-49.
  • Dang A, Thakker R, Li S, Hommel E, Mehta HB, Goodwin JS. Hospitalizations and Mortality From Non-SARS CoV-2 Causes Among Medicare Beneficiaries at US Hospitals During the SARS-CoV-2 Pandemic. JAMA Netw Open 2022;5(3):e221754.
  • Birkmeyer JD, Barnato A, Birkmeyer N, Bessler R, Skinner J. The impact of the COVID-19 pandemic on hospital admissions in the United States. Health Aff (Millwood) 2020;39(11):2010-17. Bodilsen J, Nielsen PB, Søgaard M, et al. Hospital admission and mortality rates for non-covid diseases in Denmark during covid-19 pandemic: nationwide population based cohort study. BMJ 2021;373(n1135):n1135.
  • Leafloor CW, Imsirovic H, Qureshi D, et al. Characteristics and Outcomes of ICU Patients Without COVID-19 Infection-Pandemic Versus Nonpandemic Times: A Population-Based Cohort Study. Crit Care Explor 2023;5(4):e0888.
  • Watanabe S, Shin JH, Okuno T, et al. Medium-term impacts of the waves of the COVID-19 epidemic on treatments for non-COVID-19 patients in intensive care units: A retrospective cohort study in Japan. PLoS One 2022;17(9):e0273952.
  • Bologheanu R, Maleczek M, Laxar D, Kimberger O. Outcomes of non-COVID-19 critically ill patients during the COVID-19 pandemic: A retrospective propensity score-matched analysis. Wien Klin Wochenschr 2021;133(17-18):942-50.
  • Bartolomeo N, Giotta M, Trerotoli P. In-Hospital Mortality in Non-COVID-19-Related Diseases before and during the Pandemic: A Regional Retrospective Study. Int J Environ Res Public Health 2021;18(20):10886.
  • Özgüner Y, Altinsoy S, Ermiş Y, Atar F, Sayin MM, Ergil J. Comparison of demographic and clinical characteristics between pandemic and pre-pandemic period in non-COVID intensive care units: a retrospective study. Ulus Travma Acil Cerrahi Derg 2023;29(5):560-65.
  • Kömürcü Ö,Beldağlı M,Ülger F. Pandemi Sürecinde Non-COVİD-19 Yoğun Bakım Ünitesinde Mortalite. Türk Yoğun Bakım Dergisi 2022; 20(3): 148 - 53.
  • Gasch-Illescas A, Calle-Serrano M, Vallejo-Vaz AJ, et al. Impact of the first wave of the COVID-19 pandemic on non-COVID inpatient care in southern Spain. Sci Rep 2023;13(1):1634.
  • Bord S, Tur-Sinai A, Basis F. High Non-COVID-19 in-Hospital Deaths during the First Lockdown in Israel Compared with the Second and Third Lockdowns. Int J Environ Res Public Health 2022;19(20):13134.
  • Ministry of Health of Turkish Republic. (2020). Genel koronavirüs tablosu [ cited 10 August 2023]. Avaible from: https://covid19.saglik.gov.tr/TR-66935/genel-koronavirus-tablosu.html
  • Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016;315(8):801-10.
  • Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992;45(6):613-19.
  • Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 2012;120(4):c179 c184.
  • Magiorakos AP, Srinivasan A, Carey RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18(3):268-81.
  • Çatal Y,Altıntop İ. COVID-19 Pandemisi’nin Acil Servis Başvuruları Üzerine Etkisi. Ankara Üniversitesi Tıp Fakültesi Mecmuası 2022; 75(3): 421 - 27.
  • Açıksarı K, Kınık K. Türkiye’de bir Eğitim Araştırma Hastanesi Acil Servisinde Koronavirus Hastalığı 2019 Pandemi Sürecinin Yönetimi ve Sonuçları. Anatolian Clinic the Journal of Medical Sciences 2020; 25(Special Issue on COVID 19): 263-83.
  • Kiss P, Carcel C, Hockham C, Peters SAE. The impact of the COVID-19 pandemic on the care and management of patients with acute cardiovascular disease: a systematic review. Eur Heart J Qual Care Clin Outcomes 2021;7(1):18-27.
  • Butt AA, Kartha AB, Masoodi NA, et al. Hospital admission rates, length of stay, and in-hospital mortality for common acute care conditions in COVID-19 vs. pre-COVID-19 era. Public Health 2020;189:6-11.
  • Singh B, Dogra PM, Sood V, et al. Spectrum, Outcomes, and Mortality Predictors of Acute Kidney Injury among Non-COVID-19 Patients during COVID-19 Pandemic: Data from Four Intensive Care Units. Indian J Crit Care Med 2023;27(2):119-26.

Comparison of non-COVID-19 critically ill patients between pre-pandemic and pandemic period admitted from emergency department to internal medicine intensive care unit

Year 2024, Volume: 63 Issue: 1, 106 - 114, 19.03.2024

Şükriye Miray Kılınçer Bozgül , İlkçe Akgün Kurtulmuş , Figen Yargucu , Mümtaz Yilmaz , Funda Karbek Akarca , Deniz Can Aydogan , Barış Özkılıç , Karya İslamoğlu , Güneş Ak , Fatma Feriha Çilli , Devrim Bozkurt

https://doi.org/10.19161/etd.1345563

Abstract

Aim: During the COVID-19 pandemic, a large number of intensive care unit beds have been organized for critically ill COVID-19 patients. However, the need for intensive care for non-COVID-19 critical patients continues. In our study, we aimed to compare non-COVID-19 critically ill patients admitted to the internal medicine intensive care unit from the emergency department before and during the pandemic period.
Materials and Methods: Patients who were admitted to the internal medicine intensive care unit from the emergency department were grouped as pre-pandemic (March 2018-March 2020) and during the pandemic (March 2020-March 2022) and compared retrospectively in terms of the number of hospitalisations, demographic characteristics, length of intensive care unit stay and mortality.
Results: The number of emergency department patient admissions other than surgical reasons was 579.657 during the study period. 63.33 % of these patients were admitted before the pandemic and 36.67% during the pandemic period. The number of patients included in our study was 493 before the pandemic and 460 during the pandemic period. Median age was 61 (30) in the pre-pandemic period and 64 (26.8) in the pandemic period, p=0.022. There was no significant difference in terms of comorbidities. The main reason for hospitalisation was similar and sepsis was the leading reason for hospitalisation. The frequency of acute renal failure in intensive care unit was significantly higher during the pandemic period. Mortality was 25.2% before the pandemic and 24.3% during the pandemic period, p=0.760.
Conclusion: Although emergency department admissions decreased, the number of non-COVID-19 internal medicine intensive care unit hospitalisations did not decrease. This situation reveals the importance of organising intensive care beds for hospitalisation for non-COVID-19 reasons in order not to disrupt health services during the pandemic period.

Keywords

intensive care mortality pandemic COVID-19

Ethical Statement

The study was approved by the Ege University Ethics Committee, number 23-5.1T/15

References

  • Santi L, Golinelli D, Tampieri A, et al. Non-COVID-19 patients in times of pandemic: Emergency department visits, hospitalizations and cause-specific mortality in Northern Italy. PLoS One 2021;16(3):e0248995.
  • Jeffery MM, D'Onofrio G, Paek H, et al. Trends in Emergency Department Visits and Hospital Admissions in Health Care Systems in 5 States in the First Months of the COVID-19 Pandemic in the US. JAMA Intern Med 2020;180(10):1328-33.
  • Van Damme W, Dahake R, Delamou A, et al. The COVID-19 pandemic: diverse contexts; different epidemics how and why? BMJ Glob Health 2020;5(7):e003098.
  • Tartari F, Guglielmo A, Fuligni F, Pileri A. Changes in emergency service access after spread of COVID-19 across Italy. J Eur Acad Dermatol Venereol 2020;34(8):350-51.
  • Zampieri FG, Bastos LSL, Soares M, Salluh JI, Bozza FA. The association of the COVID-19 pandemic and short-term outcomes of non-COVID-19 critically ill patients: an observational cohort study in Brazilian ICUs. Intensive Care Med 2021;47(12):1440-49.
  • Dang A, Thakker R, Li S, Hommel E, Mehta HB, Goodwin JS. Hospitalizations and Mortality From Non-SARS CoV-2 Causes Among Medicare Beneficiaries at US Hospitals During the SARS-CoV-2 Pandemic. JAMA Netw Open 2022;5(3):e221754.
  • Birkmeyer JD, Barnato A, Birkmeyer N, Bessler R, Skinner J. The impact of the COVID-19 pandemic on hospital admissions in the United States. Health Aff (Millwood) 2020;39(11):2010-17. Bodilsen J, Nielsen PB, Søgaard M, et al. Hospital admission and mortality rates for non-covid diseases in Denmark during covid-19 pandemic: nationwide population based cohort study. BMJ 2021;373(n1135):n1135.
  • Leafloor CW, Imsirovic H, Qureshi D, et al. Characteristics and Outcomes of ICU Patients Without COVID-19 Infection-Pandemic Versus Nonpandemic Times: A Population-Based Cohort Study. Crit Care Explor 2023;5(4):e0888.
  • Watanabe S, Shin JH, Okuno T, et al. Medium-term impacts of the waves of the COVID-19 epidemic on treatments for non-COVID-19 patients in intensive care units: A retrospective cohort study in Japan. PLoS One 2022;17(9):e0273952.
  • Bologheanu R, Maleczek M, Laxar D, Kimberger O. Outcomes of non-COVID-19 critically ill patients during the COVID-19 pandemic: A retrospective propensity score-matched analysis. Wien Klin Wochenschr 2021;133(17-18):942-50.
  • Bartolomeo N, Giotta M, Trerotoli P. In-Hospital Mortality in Non-COVID-19-Related Diseases before and during the Pandemic: A Regional Retrospective Study. Int J Environ Res Public Health 2021;18(20):10886.
  • Özgüner Y, Altinsoy S, Ermiş Y, Atar F, Sayin MM, Ergil J. Comparison of demographic and clinical characteristics between pandemic and pre-pandemic period in non-COVID intensive care units: a retrospective study. Ulus Travma Acil Cerrahi Derg 2023;29(5):560-65.
  • Kömürcü Ö,Beldağlı M,Ülger F. Pandemi Sürecinde Non-COVİD-19 Yoğun Bakım Ünitesinde Mortalite. Türk Yoğun Bakım Dergisi 2022; 20(3): 148 - 53.
  • Gasch-Illescas A, Calle-Serrano M, Vallejo-Vaz AJ, et al. Impact of the first wave of the COVID-19 pandemic on non-COVID inpatient care in southern Spain. Sci Rep 2023;13(1):1634.
  • Bord S, Tur-Sinai A, Basis F. High Non-COVID-19 in-Hospital Deaths during the First Lockdown in Israel Compared with the Second and Third Lockdowns. Int J Environ Res Public Health 2022;19(20):13134.
  • Ministry of Health of Turkish Republic. (2020). Genel koronavirüs tablosu [ cited 10 August 2023]. Avaible from: https://covid19.saglik.gov.tr/TR-66935/genel-koronavirus-tablosu.html
  • Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016;315(8):801-10.
  • Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992;45(6):613-19.
  • Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 2012;120(4):c179 c184.
  • Magiorakos AP, Srinivasan A, Carey RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18(3):268-81.
  • Çatal Y,Altıntop İ. COVID-19 Pandemisi’nin Acil Servis Başvuruları Üzerine Etkisi. Ankara Üniversitesi Tıp Fakültesi Mecmuası 2022; 75(3): 421 - 27.
  • Açıksarı K, Kınık K. Türkiye’de bir Eğitim Araştırma Hastanesi Acil Servisinde Koronavirus Hastalığı 2019 Pandemi Sürecinin Yönetimi ve Sonuçları. Anatolian Clinic the Journal of Medical Sciences 2020; 25(Special Issue on COVID 19): 263-83.
  • Kiss P, Carcel C, Hockham C, Peters SAE. The impact of the COVID-19 pandemic on the care and management of patients with acute cardiovascular disease: a systematic review. Eur Heart J Qual Care Clin Outcomes 2021;7(1):18-27.
  • Butt AA, Kartha AB, Masoodi NA, et al. Hospital admission rates, length of stay, and in-hospital mortality for common acute care conditions in COVID-19 vs. pre-COVID-19 era. Public Health 2020;189:6-11.
  • Singh B, Dogra PM, Sood V, et al. Spectrum, Outcomes, and Mortality Predictors of Acute Kidney Injury among Non-COVID-19 Patients during COVID-19 Pandemic: Data from Four Intensive Care Units. Indian J Crit Care Med 2023;27(2):119-26.
There are 25 citations in total.

Details

Primary Language English
Subjects Emergency Medicine, ​Internal Diseases, Intensive Care
Journal Section Research Articles
Authors

Şükriye Miray Kılınçer Bozgül 0000-0002-3995-5096

İlkçe Akgün Kurtulmuş 0000-0002-2661-8525

Figen Yargucu 0000-0001-7479-3582

Mümtaz Yilmaz 0000-0002-8585-0770

Funda Karbek Akarca 0000-0003-2455-8044

Deniz Can Aydogan 0009-0001-4330-0682

Barış Özkılıç 0000-0001-5904-7522

Karya İslamoğlu 0000-0002-0941-6235

Güneş Ak 0000-0001-6780-1812

Fatma Feriha Çilli 0000-0003-3993-3396

Devrim Bozkurt 0000-0003-4557-3390

Publication Date March 19, 2024
Submission Date September 4, 2023
Published in Issue Year 2024Volume: 63 Issue: 1

Cite

Vancouver Kılınçer Bozgül ŞM, Kurtulmuş İA, Yargucu F, Yilmaz M, Karbek Akarca F, Aydogan DC, Özkılıç B, İslamoğlu K, Ak G, Çilli FF, Bozkurt D. Comparison of non-COVID-19 critically ill patients between pre-pandemic and pandemic period admitted from emergency department to internal medicine intensive care unit. EJM. 2024;63(1):106-14.
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