Cohort of 4404 Persons Under Investigation for COVID-19 in a NY Hospital and Predictors of ICU Care and Ventilation

Study objective: Most COVID-19 reports have focused on SARS-CoV-2 positive patients. However, at the time of initial presentation, most patients’ viral status is unknown. Determination of factors that predict initial and subsequent need for intensive care (ICU) and invasive mechanical ventilation (IMV) are critical for resource planning and allocation. We describe our experience with 4,404 persons under investigation (PUI) and explore predictors of ICU care and IMV at a NY COVID-19 epicenter.

Methods: We conducted a retrospective COHORT of all persons under investigation (PUI) presenting to a large academic medical center emergency department (ED) in NYS with symptoms suggestive of COVID-19. The association between patient predictor variables and SARS-CoV-2 status, intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), and mortality were explored with univariate and multivariate analyses.

Results: Between March 13-April 14, 2020 we saw 4,404 PUI patients of whom 68% were discharged home, 29% were admitted to a regular floor and 3% to an ICU. Of regular floor admits, 13% were subsequently upgraded to the ICU after a median (IQR) of 62 (28-106) hrs. 50 patients required IMV in the ED, 4 required prehospital IMV, and another 167 subsequently required IMV in a median (IQR) of 60 (26-9) hours after admission. Testing positive for SARS-CoV-2 and lower oxygen saturations were associated with need for ICU, IMV and death. High respiratory rates were associated with the need for ICU care.

Conclusions: PUI for COVID-19 contribute significantly to the healthcare burden beyond those ruling in for SARS-CoV-2. For every 100 admitted PUI, 9 will require ICU and/or IMV upon arrival and another 12 within 2-3 days of hospital admission, especially PUIs with lower oxygen saturations and positive SARS-CoV-2 swabs. This information should help hospitals stay ahead of the pandemic curve.

Note: Funding: None.

Conflict of Interest: None.

Ethical Approval: Because of the retrospective design, we received IRB approval with waiver of informed consent.

Keywords: COVID-19, persons under investigation, mechanical ventilation, intensive care

Suggested Citation: Suggested Citation

Singer, Adam and Morley, Eric J. and Meyers, Kristen and Fernandes, Rafael and Rowe, Alison L. and Viccellio, Peter and Thode, Henry C. and Bracey, Alexander and Henry, Mark C., Cohort of 4404 Persons Under Investigation for COVID-19 in a NY Hospital and Predictors of ICU Care and Ventilation (April 23, 2020). Annals of Emergency Medicine, Forthcoming, Available at SSRN: https://ssrn.com/abstract=3583678 or http://dx.doi.org/10.2139/ssrn.3583678