COVID-19, Mortality, Pandemic, Severe acute respiratory infection, Treatment and diagnosis delay
Citation Information :
Arunachala S, Venkatesh BT, Bhatt MT, Puranik A, Rao S. COVID-19 Pandemic: Impact on Admission, Diagnosis, and Treatment of Non-COVID-19 Patients Admitted to SARI ICU. Indian J Crit Care Med 2021; 25 (8):853-859.
Background: Coronavirus disease 2019 (COVID-19) pandemic has caused a huge burden on healthcare services worldwide, severely affecting the management of non-COVID-19 patients as well. The Government of India has updated guidelines for the clinical management of COVID-19 illness, including severe acute respiratory infections (SARI) definition for triaging suspected COVID-19 cases in an isolated intensive care unit (ICU). The aim of this study was to estimate the adherence of clinicians in triaging COVID-19 suspects as per SARI definition to SARI ICU. This study also observed the impact of such triaging on admission, diagnosis, and treatment process of non-COVID-19 patients admitted to SARI ICU.
Patients and methods: This cross-sectional study was conducted in a designated SARI ICU of two tertiary care medical college hospitals involving 78 patients from the month of June to July 2020. Data related to demographics, the severity of illness, advanced life supports, delay in diagnosis, intervention, and treatment of patients in SARI ICU due to suspected COVID-19 status were documented.
Results: Adherence to SARI definition for triaging COVID-19-suspect cases was 19.2%. Despite hindrance in diagnosis (17.9%) and treatment (12.8%), mortality among patients in SARI ICU was limited to 14.10%. Results were insignificant when checked for various factors associated with mortality.
Conclusion: Nonadherence to SARI definition may lead to undue delay in diagnosis, intervention, and treatment of non-COVID-19 cases. This may result in increased morbidity, mortality, and economic burden on patients and the healthcare system.
key message: A rationale and just utilization of healthcare resources are need of the hour in the face of an enormous volume of SARI cases during COVID-19 pandemic. SARI criteria as implemented by the Ministry of Health and Family Welfare (MOHFW), Government of India, are a very important tool in triaging of COVID-19-suspect cases. Adequate measures should be in place in order to mitigate the inadequacies and deficiencies in the treatment of non-COVID-19 cases, which have occurred as a result of COVID-19 pandemic.
World Health Organization [homepage on the Internet]. Geneva: WHO characterizes COVID-19 as a pandemic [cited 2020 March 11]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-asthey- happen.
Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020;382(13):1199–1207. DOI: 10.1056/NEJMoa2001316.
Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020;8(5):475–481. DOI: 10.1016/S2213-2600(20)30079-5 [Erratum in: Lancet Respir Med 2020;8(4):e26]. PMID: 32105632; PMCID: PMC7102538.
Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. China medical treatment expert group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382(18):1708–1720. DOI: 10.1056/NEJMoa2002032. PMID: 32109013; PMCID: PMC7092819.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult in patients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395(10229): 1054–1062. DOI: 10.1016/S0140-6736(20)30566-3 [Erratum in: Lancet 2020;395(10229):1038]. PMID: 32171076; PMCID: PMC7270627.
Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007;44(Suppl. 2):S27–S72. DOI: 10.1086/511159. PMID: 17278083; PMCID: PMC7107997.
Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the working group on sepsis-related problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22(7):707–710. DOI: 10.1007/BF01709751. PMID: 8844239.
Guidelines on clinical management of severe acute respiratory illness (SARI) in suspect/confirmed novel coronavirus (nCoV) cases. Available from: https://main.mohfw.gov.in/sites/default/files/Guidelines%20on%20Clinical%20management%20of%20severe%20acute%20respiratory%20illness.pdf.
Divatia JV, Amin PR, Ramakrishnan N, Kapadia FN, Todi S, Sahu S, et al; INDICAPS Study Investigators. Intensive Care in India: The Indian intensive care case mix and practice patterns study. Indian J Crit Care Med 2016;20(4):216–225. DOI: 10.4103/0972-5229.180042. PMID: 27186054; PMCID: PMC4859158.
Mk MV, Krishna B, Sampath S. Secular trends in an Indian intensive care unit-database derived epidemiology: the stride study. Indian J Crit Care Med 2019;23(6):251–257. DOI: 10.5005/jp-journals-10071-23175. PMID: 31435142; PMCID: PMC6698356.
Vincent JL, Marshall JC, Namendys-Silva SA, François B, Martin-Loeches I, Lipman J, et al; ICON investigators. Assessment of the worldwide burden of critical illness: the intensive care over nations (ICON) audit. Lancet Respir Med 2014;2(5):380–386. DOI: 10.1016/S2213-2600(14)70061-X. PMID: 24740011.
Álvarez-Lerma F, Marín-Corral J, Vila C, Masclans JR, de Molina FJ, Loeches IM, et al. Delay in diagnosis of influenza A (H1N1) pdm09 virus infection in critically ill patients and impact on clinical outcome. Crit Care 2016;20(1):337. DOI: 10.1186/s13054-016-1512-1.
Soares DM, Pessanha JF, Sharma A, Brocca A, Ronco C. Delayed nephrology consultation and high mortality on acute kidney injury: a meta-analysis. Blood Purif 2017;43(1–3):57–67. DOI: 10.1159/000452316.
Martínez ML, Ferrer R, Torrents E, Guillamat-Prats R, Gomà G, Suárez D, et al. Impact of source control in patients with severe sepsis and septic shock. Crit Care Med 2017;45(1):11–19. DOI: 10.1097/CCM.0000000000002011.
Checkley W, Martin GS, Brown SM, Chang SY, Dabbagh O, Fremont RD, et al; United States critical illness and injury trials group critical illness outcomes study investigators. Structure, process, and annual ICU mortality across 69 centers: United States critical illness and injury trials group critical illness outcomes study. Crit Care Med 2014;42(2):344–356. DOI: 10.1097/CCM.0b013e3182a275d7. PMID: 24145833; PMCID: PMC4035482.
Park J, Jeon K, Chung CR, Yang JH, Cho YH, Cho J, et al. A nationwide analysis of intensive care unit admissions, 2009–2014 – The Korean ICU National Data (KIND) study. J Crit Care 2018;44:24–30. DOI: 10.1016/j.jcrc.2017.09.017. PMID: 29028553.
Arevalo-Rodriguez I, Buitrago-Garcia D, Simancas-Racines D, Zambrano-Achig P, Del Campo R, Ciapponi A, et al. False-negative results of initial RT-PCR assays for COVID-19: a systematic review. PLoS One 2020;15(12):e0242958. DOI: 10.1371/journal.pone.0242958.
Wang W, Xu Y, Gao R, Lu R, Han K, Wu G, et al. Detection of SARS-CoV-2 in different types of clinical specimens. JAMA 2020;323(18): 1843–1844. DOI: 10.1001/jama.2020.3786. PMID: 32159775; PMCID: PMC7066521.