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. 2021 Mar 3;5(4):1411.
doi: 10.23889/ijpds.v5i4.1411.

Length of Stay in ICU of Covid-19 patients in England, March - May 2020

Nick Shryane  1 , Maria Pampaka  1 , Andrea Aparicio-Castro  1 , Shazaad Ahmad  2 , Mark J Elliot  1 , Jihye Kim  1 , Jennifer Murphy  1 , Wendy Olsen  1 , Diego Pérez Ruiz  1 , Arkadiusz Wiśniowski  1
Affiliations

Length of Stay in ICU of Covid-19 patients in England, March - May 2020

Nick Shryane et al. Int J Popul Data Sci. .

Abstract

Introduction: Length of Stay (LoS) in Intensive Care Units (ICUs) is an important measure for planning beds capacity during the Covid-19 pandemic. However, as the pandemic progresses and we learn more about the disease, treatment and subsequent LoS in ICU may change.

Objectives: To investigate the LoS in ICUs in England associated with Covid-19, correcting for censoring, and to evaluate the effect of known predictors of Covid-19 outcomes on ICU LoS.

Data sources: We used retrospective data on Covid-19 patients, admitted to ICU between 6 March and 24 May, from the "Covid-19 Hospitalisation in England Surveillance System" (CHESS) database, collected daily from England's National Health Service, and collated by Public Health England.

Methods: We used Accelerated Failure Time survival models with Weibull and log-normal distributional assumptions to investigate the effect of predictors, which are known to be associated with poor Covid-19 outcomes, on the LoS in ICU.

Results: Patients admitted before 25 March had significantly longer LoS in ICU (mean = 18.4 days, median = 12), controlling for age, sex, whether the patient received Extracorporeal Membrane Oxygenation, and a co-morbid risk factors score, compared with the period after 7 April (mean = 15.4, median = 10). The periods of admission reflected the changes in the ICU admission policy in England. Patients aged 50-65 had the longest LoS, while higher co-morbid risk factors score led to shorter LoS. Sex and ethnicity were not associated with ICU LoS.

Conclusions: The skew of the predicted LoS suggests that a mean LoS, as compared with median, might be better suited as a measure used to assess and plan ICU beds capacity. This is important for the ongoing second and any future waves of Covid-19 cases and potential pressure on the ICU resources. Also, changes in the ICU admission policy are likely to be confounded with improvements in clinical knowledge of Covid-19.

Keywords: COVID-19; England; intensive care; length of stay; survival analysis.

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Conflict of interest statement

Statement on conflicts of interest: All authors declare that they have no conflicts of interest.

Figures

Figure 1: Distribution of mean predicted LoS in ICU
Figure 1: Distribution of mean predicted LoS in ICU
See this image and copyright information in PMC

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