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COVID-19 Insights & Analytics Issue 4
Changes in LOS & Mortality in Second Surge

Aug 20, 2020

Overview

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The COVID-19 Insights & Analytics newsletter is designed to provide you with a summary to quantify national trends that may help in COVID-19 response planning. The included data, analytics and dashboards are generated utilizing BD HealthSight™ Infection Advisor Analytics and are derived from electronic patient data from 338 participating U.S. hospitals initiated on March 1, 2020 through August 17, 2020 unless otherwise indicated.

Introduction

Thus far in the pandemic, reports of severe COVID-19 admissions requiring ICU stay and complicated cases with high relative mortality have been reported (1-4). This issue will focus on unique LOS (length of stay) and mortality insights within our database.

Executive Summary

  • Overall LOS in SARS-CoV-2 tested patients has reduced by 1 day, from 7.5 early in the pandemic to 6.5 in August. This reduction is driven by negative tested patients having a total LOS decrease from 7.0 to 6.1 days, while positive tested patients remain constant (9.7 days).
  • Patient mortality rates may be decreasing for hospitalized COVID-19 (SARS-CoV-2 positive) patients. This trend is reflected among positive tested ICU patients (37.4% to 31.1%) and less percentage of positive tested patients admitted to an ICU (10.6% to 6.7%).
  • While overall LOS is decreasing, corresponding decreases in COVID-19 patient mortality and younger ages admitted may indicate these observational trends may be linked (i.e., younger COVID-19 patients may have lower mortality, which may also affect total average LOS metrics). Hospital level awareness of average LOS trends in certain COVID-19 positive demographics may help inform appropriate staffing and resource allocation.

Figure 1: Admission demographics by test result status (March 1 – August 17, 2020)

Figure 2: Admission demographics by test result status (March 1 – May 3, 2020)

Figure 1 & 2 are cumulative for their time frame. All patients admitted to ER or inpatient, who were administered a COVID-19 test, are included.

Commentary for Figure 1 and 2

  • Overall LOS for patients tested for SARS-CoV-2 decreased from 7.5 to 6.4, driven by the test negative group decreasing from 7.0 to 6.0. This may be due to lower acuity of the patients testing negative as supported by a lower percentage requiring ICU stay (15.6% vs 21.9%).
  • The total LOS for test positive patients was relatively constant for both time periods (9.7 to 9.8 days), however the ICU LOS increased from 7.8 to 8.8 days. This may be due to multiple factors such as: purported recrudescence of COVID-19 disease (5); a function of operational ICU bed availability and capacity (6); and/or a decrease in the average age of COVID-19 patients (7). These factors may be contributing to signals that suggest higher overall survival rates and longer ICU stays.

Figure Figure 3: Mortality & Length of Stay (LOS) (March 1 – August 17, 2020)

Figure 4: Mortality & Length of Stay (LOS) (March 1 – May 3, 2020)

Mortality is determined from the patient discharge disposition. If the discharge information is incomplete, patients are not included in the above analysis.

Commentary for Figure 3 and 4

  • COVID-19 positive patients have a longer LOS than patients with negative test results. This is true in both the recovered and expired subsets.
  • An increase in mortality correlates to a longer LOS for both positives & negatives with the positive group having 10-15 points higher percent mortality. This relationship has stayed relatively constant in both time sets.
  • Patient mortality for positive tested ICU patients dropped from 37.4% to 30.8%, and among positive patients not requiring ICU mortality dropped from 10.6% to 6.3%. This may be due to incremental improvements in COVID-19 care as clinicians build experience treating COVID-19 patients, and/or a decrease in average age of COVID-19 patients leading to greater survivability.

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