Taccone et al., The role of organizational characteristics on the outcome of COVID-19 patients admitted to the ICU in Belgium, The Lancet Regional Health - Europe, doi:10.1016/j.lanepe.2020.100019
risk of death, 24.7% lower, RR 0.75, p = 0.02, treatment 449 of 1,308 (34.3%), control 183 of 439 (41.7%), NNT 14, odds ratio converted to relative risk.
Abstract: The Lancet Regional Health - Europe 2 (2021) 100019
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The Lancet Regional Health - Europe
journal homepage: www.elsevier.com/lanepe
Research paper
The role of organizational characteristics on the outcome of COVID-19
patients admitted to the ICU in Belgium
Fabio Silvio Tacconea,1,*, Nina Van Goethemb,1,*, Robby De Pauwb, Xavier Wittebolec,
Koen Blotb, Herman Van Oyenb,d, Tinne Lernoutb, Marion Montourcyb, Geert Meyfroidte,#,
Dominique Van Beckhovenb,#, on behalf of the Belgian Society of Intensive Care Medicine and
the Belgian Collaborative Group on COVID-19 Hospital Surveillance
Department of Intensive Care, Erasme Hospital, Universite Libre de Bruxelles (ULB), Brussels, Belgium
Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
Department of Intensive Care, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
d
Department of Public Health and Primary Care, University of Gent, Gent, Belgium
e
Department of Intensive Care Medicine, University of Leuven, Leuven, Belgium
a
b
c
A R T I C L E
I N F O
Article History:
Received 28 October 2020
Revised 6 December 2020
Accepted 18 December 2020
Available online 23 December 2020
Keywords:
COVID-19
Mortality
Intensive care unit
Organisation
Surge
A B S T R A C T
Background: Several studies have investigated the predictors of in-hospital mortality for COVID-19
patients who need to be admitted to the Intensive Care Unit (ICU). However, no data on the role of organizational issues on patients’ outcome are available in this setting. The aim of this study was therefore to
assess the role of surge capacity organisation on the outcome of critically ill COVID-19 patients admitted
to ICUs in Belgium.
Methods: We conducted a retrospective analysis of in-hospital mortality in Belgian ICU COVID-19
patients via the national surveillance database. Non-survivors at hospital discharge were compared to
survivors using multivariable mixed effects logistic regression analysis. Specific analyses including only
patients with invasive ventilation were performed. To assess surge capacity, data were merged with
administrative information on the type of hospital, the baseline number of recognized ICU beds, the
number of supplementary beds specifically created for COVID-19 ICU care and the “ICU overflow” (i.e.
a time-varying ratio between the number of occupied ICU beds by confirmed and suspected COVID-19
patients divided by the number of recognized ICU beds reserved for COVID-19 patients; ICU overflow
was present when this ratio is 1.0).
Findings: Over a total of 13,612 hospitalised COVID-19 patients with admission and discharge forms registered in the surveillance period (March, 1 to August, 9 2020), 1903 (14.0%) required ICU admission, of
whom 1747 had available outcome data. Non-survivors (n = 632, 36.1%) were older and had more frequently various comorbid diseases than survivors. In the multivariable analysis, ICU overflow, together
with older age, presence of comorbidities, shorter delay between symptom onset and hospital admission, absence of hydroxychloroquine therapy and use of invasive mechanical ventilation and of ECMO,
was independently associated with an increased in-hospital mortality. Similar results were found in in
in the subgroup of invasively ventilated patients. In addition, the proportion of supplementary beds specifically created for COVID-19 ICU care to the previously existing total number of ICU beds was associated..
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