Striking differences revealed in COVID-19 mortality between NHS trusts

Anonymous — Fri, 12 Jun 2020 09:28:57 +0000

Using data science techniques, the team revealed that the NHS trust in which a COVID-19 patient ended up in intensive care is as important, in terms of the risk of death, as the strongest patient-specific risk factors such as older age, immunosuppression or chronic heart/kidney disease. In the worst case, COVID-19 patients in the intensive care unit (ICU) of a particular NHS trust were over four times as likely to die in a given time period than COVID-19 patients in an average trust’s ICU.

From the earliest days of the coronavirus pandemic, clinicians and scientists have been deciphering the risk factors that make someone with COVID-19 more likely to die. ̽��ֱ��uncovering of determinants of risk has allowed doctors to focus resources on the most vulnerable patients and has proved important in planning for the surge in demand for intensive care units created by the pandemic. It has also informed the public of which groups should take greater measures to shield or socially distance themselves. ̽��ֱ��new study, published in the journal Intensive Care Medicine, is the first to reveal the extent to which ICU-patient location is a factor.

“COVID-19 has stretched most ICUs well beyond their normal capacity and necessitated them finding additional space, equipment and skilled staff – in an already stretched NHS – to deal with demand for highly specialist life-supporting therapies,” says Dr Ercole. “It is possible that some hospitals found this harder either because they didn’t have time to react or the necessary resources. It is crucial to understand the reasons for these between-centre differences as we plan our response to similar situations in the future: how and where to build capacity, and how to use what we have most effectively.”

̽��ֱ��analysis was carried out on anonymised data from the COVID-19 Hospitalisation in England Surveillance System (CHESS) dataset, supplied by Public Health England. ̽��ֱ��data were anonymised not only in terms of the patients but also in terms of the NHS trusts. ̽��ֱ��data covered 8 February to 22 May, during which there were 5062 ICU cases in 94 NHS trusts across England, with 1547 patient deaths and 1618 discharges from ICU.

̽��ֱ��researchers call for urgent “comparative effectiveness research” to get to the bottom of these marked differences between NHS trusts. Knowledge gained in this direction could inform how ICUs are optimised and improve best practice in dealing with surges in COVID-19 cases in England, and perhaps beyond.

Reference:
Zhaozhi Qian et al. 'Between-centre differences for COVID-19 ICU mortality from early data in England.' Intensive Care Medicine (2020). DOI: 10.1007/s00134-020-06150-y

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A ̽��ֱ�� of Cambridge team led by Professor Mihaela van der Schaar and intensive care consultant Dr Ari Ercole of the Cambridge Centre for AI in Medicine (CCAIM) is calling for urgent research into the striking differences in COVID-19 deaths they have discovered between the intensive care units of NHS trusts across England.

It is crucial to understand the reasons for these between-centre differences as we plan our response to similar situations in the future

Ari Ercole

Yuri Samoilov

Coronavirus

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Intensive care units in England could run out of beds within two weeks, study finds

cjb250 — Tue, 24 Mar 2020 13:32:31 +0000

Since emerging in November 2019, there have been over 267,000 confirmed cases of COVID-19 coronavirus and over 11,200 deaths (WHO figures 22 March). While COVID-19 generally causes mild symptoms, some patients may develop severe lung inflammation. This may be severe enough to require intensive care for advanced, invasive mechanical ventilation (‘life support’).

Mechanical ventilation is a specialised procedure that can only be provided on an intensive care unit. ̽��ֱ��number of intensive care beds is limited and the equipment and specialist staffing required makes it difficult to create more ICU beds easily/quickly. In Northern Italy, which has been particularly severely affected, the large volumes of patients has overwhelmed ICU capacity.

“If mechanical ventilation cannot be provided to patients who need it, they will die,” says Dr Ari Ercole from the Division of Anaesthesia at the ̽��ֱ�� of Cambridge. “ICU capacity is a crucial concern as additional capacity takes time to create both in terms of staffing and equipment.”

Dr Ercole and colleagues from Cambridge’s Division of Anaesthesia and Department of Computer Science and Technology have built a real-time computer model to try and make the earliest possible predictions of ICU demand in England. Their aim is to give an early warning of when or whether capacity will become critical and give as much advanced notice as possible to help build capacity.

Because of the urgent implications of the model’s results, the team has made its study available online early. ̽��ֱ��research has not been peer-reviewed. All source code has been made freely-available online.

̽��ֱ��team used COVID-19 diagnoses from England as reported by Public Health England and matched to NHS commissioning regions as its source data to obtain information on daily cases. They have assumed that the daily incidence of COVID-19 can be modelled as an exponential growth, in line with what has been observed in Italy. ̽��ֱ��most up-to-date information suggests the median length of time spent in an ICU is eight days.

̽��ֱ��Cambridge model predicts that ICU demand in England could rise to levels which are impossible to supply with the current beds available very quickly – as early as within two weeks in some regions and with London at particular risk.

“If our assumptions are correct, ICU capacity may be complete overwhelmed very quickly in England,” added Dr Ercole, who is also a Fellow in Clinical Medicine at Magdalene College. “A large increase in ICU capacity is required extremely urgently if we are to be able to treat patients with life-threatening COVID-19 in the near future.”

̽��ֱ��model makes a number of assumptions about the outbreak which may limit its accuracy, but is based on the best available data at the earliest time.

̽��ֱ��team used data published by Public Health England. While the researchers acknowledge this data does not recognise all cases within the wider population, it is likely to include the vast majority of severe cases, on which the models specifically focus. Changes over time in World Health Organization case definitions and in surveillance strategies may also overestimate ICU admission rates as milder cases were not identified initially and would artificially inflate the forecast numbers.

They have forecast the percentage of COVID-19 bed requirements in isolation. In reality, all ICUs will need to continue to provide ‘business as usual’ care for other types of patients. Since UK bed occupancy is typically greater than 80% and may frequently exceed 100%, the researchers say it is clearly not the case that all open beds can simply be re-allocated for COVID-19 patients.

They have also assumed that all adult critical care beds can be used for level 3 or mechanically ventilated ICU patients, which may not be possible; some specialist ICUs may not be able to reconfigure at all.

Listen to Dr Ercole on the Naked Scientists podcast.

Reference
Deasy, J et al. Forecasting Ultra-early Intensive Care Strain from COVID-19 in England. DOI: 10.1101/2020.03.19.20039057

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Intensive care unit (ICU) occupancy is likely to increase dramatically over the next few weeks, suggests research published by a team at the ̽��ֱ�� of Cambridge. Their work suggests that if the current exponential growth of COVID-19 infections continues, then within two weeks, five out of seven commissioning regions in England will have more critically ill COVID-19 patients than can be accommodated with ICU beds normally available.

ICU capacity is a crucial concern as additional capacity takes time to create both in terms of staffing and equipment

Ari Ercole

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Clinicians in Intensive Care Unit

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̽��ֱ�� of Cambridge - Ari Ercole

Striking differences revealed in COVID-19 mortality between NHS trusts

How you can support Cambridge's COVID-19 research effort

Intensive care units in England could run out of beds within two weeks, study finds

How you can support Cambridge's COVID-19 research effort