scholarly journals Characterization and clinical course of 1000 patients with coronavirus disease 2019 in New York: retrospective case series

BMJ ◽  
2020 ◽  
pp. m1996 ◽  
Author(s):  
Michael G Argenziano ◽  
Samuel L Bruce ◽  
Cody L Slater ◽  
Jonathan R Tiao ◽  
Matthew R Baldwin ◽  
...  
Keyword(s):  
Emergency Department ◽  
New York ◽  
New York City ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Symptom Onset ◽  
Medical Center ◽  
Kidney Injury ◽  
Bimodal Distribution ◽  
Presenting Symptoms

Abstract Objective To characterize patients with coronavirus disease 2019 (covid-19) in a large New York City medical center and describe their clinical course across the emergency department, hospital wards, and intensive care units. Design Retrospective manual medical record review. Setting NewYork-Presbyterian/Columbia University Irving Medical Center, a quaternary care academic medical center in New York City. Participants The first 1000 consecutive patients with a positive result on the reverse transcriptase polymerase chain reaction assay for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who presented to the emergency department or were admitted to hospital between 1 March and 5 April 2020. Patient data were manually abstracted from electronic medical records. Main outcome measures Characterization of patients, including demographics, presenting symptoms, comorbidities on presentation, hospital course, time to intubation, complications, mortality, and disposition. Results Of the first 1000 patients, 150 presented to the emergency department, 614 were admitted to hospital (not intensive care units), and 236 were admitted or transferred to intensive care units. The most common presenting symptoms were cough (732/1000), fever (728/1000), and dyspnea (631/1000). Patients in hospital, particularly those treated in intensive care units, often had baseline comorbidities including hypertension, diabetes, and obesity. Patients admitted to intensive care units were older, predominantly male (158/236, 66.9%), and had long lengths of stay (median 23 days, interquartile range 12-32 days); 78.0% (184/236) developed acute kidney injury and 35.2% (83/236) needed dialysis. Only 4.4% (6/136) of patients who required mechanical ventilation were first intubated more than 14 days after symptom onset. Time to intubation from symptom onset had a bimodal distribution, with modes at three to four days, and at nine days. As of 30 April, 90 patients remained in hospital and 211 had died in hospital. Conclusions Patients admitted to hospital with covid-19 at this medical center faced major morbidity and mortality, with high rates of acute kidney injury and inpatient dialysis, prolonged intubations, and a bimodal distribution of time to intubation from symptom onset.

scholarly journals Characterization and clinical course of 1000 patients with COVID-19 in New York: retrospective case series

2020 ◽  
Author(s):  
Michael G Argenziano ◽  
Samuel L Bruce ◽  
Cody L Slater ◽  
Jonathan R Tiao ◽  
Matthew R Baldwin ◽  
...  
Keyword(s):  
New York ◽  
Medical Record ◽  
Symptom Onset ◽  
Clinical Course ◽  
Medical Center ◽  
Academic Medical Center ◽  
Bimodal Distribution ◽  
Hospitalized Patients ◽  
Icu Patients ◽  
Presenting Symptoms

AbstractObjectiveTo characterize patients with coronavirus disease 2019 (COVID-19) in a large New York City (NYC) medical center and describe their clinical course across the emergency department (ED), inpatient wards, and intensive care units (ICUs).DesignRetrospective manual medical record review.SettingNewYork-Presbyterian/Columbia University Irving Medical Center (NYP/CUIMC), a quaternary care academic medical center in NYC.ParticipantsThe first 1000 consecutive patients with laboratory-confirmed COVID-19.MethodsWe identified the first 1000 consecutive patients with a positive RT-SARS-CoV-2 PCR test who first presented to the ED or were hospitalized at NYP/CUIMC between March 1 and April 5, 2020. Patient data was manually abstracted from the electronic medical record.Main outcome measuresWe describe patient characteristics including demographics, presenting symptoms, comorbidities on presentation, hospital course, time to intubation, complications, mortality, and disposition.ResultsAmong the first 1000 patients, 150 were ED patients, 614 were admitted without requiring ICU-level care, and 236 were admitted or transferred to the ICU. The most common presenting symptoms were cough (73.2%), fever (72.8%), and dyspnea (63.1%). Hospitalized patients, and ICU patients in particular, most commonly had baseline comorbidities including of hypertension, diabetes, and obesity. ICU patients were older, predominantly male (66.9%), and long lengths of stay (median 23 days; IQR 12 to 32 days); 78.0% developed AKI and 35.2% required dialysis. Notably, for patients who required mechanical ventilation, only 4.4% were first intubated more than 14 days after symptom onset. Time to intubation from symptom onset had a bimodal distribution, with modes at 3-4 and 9 days. As of April 30, 90 patients remained hospitalized and 211 had died in the hospital.ConclusionsHospitalized patients with COVID-19 illness at this medical center faced significant morbidity and mortality, with high rates of AKI, dialysis, and a bimodal distribution in time to intubation from symptom onset.

scholarly journals Acute Peritoneal Dialysis During the COVID-19 Pandemic at Bellevue Hospital in New York City

2020 ◽  
Author(s):  
Nina J Caplin ◽  
Olga Zhdanova ◽  
Manish Tandon ◽  
Nathan Thompson ◽  
Dhwanil Patel ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
New York ◽  
Acute Kidney Injury ◽  
New York City ◽  
Renal Function ◽  
Intensive Care ◽  
Peritoneal Dialysis ◽  
Kidney Injury ◽  
Bellevue Hospital ◽  
Kidney Replacement Therapy

The COVID-19 pandemic created an unprecedented strain on hospitals in New York City. Although practitioners focused on the pulmonary devastation, resources for the provision of dialysis proved to be more constrained. To deal with these shortfalls, NYC Health and Hospitals/Bellevue, NYU Brooklyn, NYU Medical Center and the New York Harbor VA Healthcare System, put together a plan to offset the anticipated increased needs for kidney replacement therapy. Prior to the pandemic, peritoneal dialysis was not used for acute kidney injury at Bellevue Hospital. We were able to rapidly establish an acute peritoneal dialysis program at Bellevue Hospital for acute kidney injury patients in the intensive care unit. A dedicated surgery team was assembled to work with the nephrologists for bedside placement of the peritoneal dialysis catheters. A multi-disciplinary team was trained by the lead nephrologist to deliver peritoneal dialysis in the intensive care unit. Between April 8, 2020 and May 8, 2020, 39 peritoneal dialysis catheters were placed at Bellevue Hospital. 38 patients were successfully started on peritoneal dialysis. As of June 10, 2020, 16 patients recovered renal function. One end stage kidney disease patient was converted to peritoneal dialysis and was discharged. One catheter was poorly functioning, and the patient was changed to hemodialysis before recovering renal function. There were no episodes of peritonitis and nine incidents of minor leaking, which resolved. Some patients received successful peritoneal dialysis while being ventilated in the prone position. In summary, despite severe shortages of staff, supplies and dialysis machines during the COVID-19 pandemic, we were able to rapidly implement a de novo peritoneal dialysis program which enabled provision of adequate kidney replacement therapy to all admitted patients who needed it. Our experience is a model for the use of acute peritoneal dialysis in crisis situations.

scholarly journals COVID-19 presenting as anosmia and dysgeusia in New York City emergency departments, March - April, 2020

2020 ◽  
Author(s):  
Tina Z. Wang ◽  
Jessica Sell ◽  
Don Weiss ◽  
Ramona Lall
Keyword(s):  
Emergency Department ◽  
New York ◽  
New York City ◽  
York City ◽  
Emergency Departments ◽  
Clinical Laboratory ◽  
Disease Diagnosis ◽  
Emergency Department Visits ◽  
Cross Sectional ◽  
Presenting Symptoms

AbstractBackgroundIncreasing evidence has been emerging of anosmia and dysgeusia as frequently reported symptoms in COVID-19. Improving our understanding of these presenting symptoms may facilitate the prompt recognition of the disease in emergency departments and prevent further transmission.MethodsWe examined a cross-sectional cohort using New York City emergency department syndromic surveillance data for March and April 2020. Emergency department visits for anosmia and/or dysgeusia were identified and subsequently matched to the Electronic Clinical Laboratory Reporting System to determine testing results for SARS-CoV-2.ResultsOf the 683 patients with anosmia and/or dysgeusia included, SARS-CoV-2 testing was performed for 232 (34%) and 168 (72%) were found to be positive. Median age of all patients presenting with anosmia and/or dysgeusia symptoms was 38, and 54% were female. Anosmia and/or dysgeusia was the sole complaint of 158 (23%) patients, of whom 35 were tested for SARS-CoV-2 and 23 (66%) were positive. While the remaining patients presented with at least one other symptom, nearly half of all patients (n=334, 49%) and more than a third of those who tested positive (n=62, 37%) did not have any of the CDC-established symptoms used for screening of COVID-19 such as fever, cough, shortness of breath, or sore throat.Conclusions and RelevanceAnosmia and/or dysgeusia have been frequent complaints among patients presenting to emergency departments during the COVID-19 pandemic, and, while only a small proportion of patients ultimately underwent testing for SARS-CoV-19, the majority of patients tested have been positive. Anosmia and dysgeusia likely represent underrecognized symptoms of COVID-19 but may have important future implications in disease diagnosis and surveillance.

scholarly journals The Face of COVID-19: Facial Pressure Wounds Related to Prone Positioning in Patients Undergoing Ventilation in the Intensive Care Unit

2020 ◽  
pp. 019459982095147
Author(s):  
Sydney T. Jiang ◽  
Christina H. Fang ◽  
Jen-Ting Chen ◽  
Richard V. Smith
Keyword(s):  
Intensive Care Unit ◽  
New York ◽  
New York City ◽  
Intensive Care ◽  
Respiratory Distress ◽  
York City ◽  
Medical Center ◽  
Prone Positioning ◽  
The Face

In the setting of COVID-19 (coronavirus disease 2019)–associated moderate and severe acute respiratory distress, persistently hypoxemic patients often require prone positioning for >16 hours. We report facial pressure wounds and ear necrosis as a consequence of prone positioning in patients undergoing ventilation in the intensive care unit in a tertiary medical center in New York City.

Unconvinced of Value of Antenatal Transfer to Level 3 Intensive Care Units

PEDIATRICS ◽  
1985 ◽  
Vol 75 (4) ◽  
pp. 801-801
Author(s):  
SAMUEL SEPKOWITZ
Keyword(s):  
New York ◽  
New York City ◽  
Intensive Care ◽  
Birth Weight ◽  
Intensive Care Units ◽  
York City ◽  
Weight Category ◽  
Neonatal Deaths ◽  
Extensive Analysis ◽  
Level 3

To the Editor.— Paneth et al1 have focused on neonatal deaths occurring at less than 4 hours of age in their extensive analysis of singleton deaths (birth weight 501 to 2,250 g) during 1976 to 1978 in New York City. Despite a well-developed transfer service, 33.6% (655/1948) of all neonatal deaths in this weight category and 42% of all deaths among infants with birth weight less than 1,001 g occurred in the first four hours of life and nearly all occurred in the hospital of birth.

scholarly journals COVID-19-Associated Critical Illness—Report of the First 300 Patients Admitted to Intensive Care Units at a New York City Medical Center

2020 ◽  
Vol 35 (10) ◽  
pp. 963-970 ◽  
Author(s):  
Sudham Chand ◽  
Sumit Kapoor ◽  
Deborah Orsi ◽  
Melissa J. Fazzari ◽  
Tristan G. Tanner ◽  
...  
Keyword(s):  
United States ◽  
New York ◽  
Mechanical Ventilation ◽  
New York City ◽  
Intensive Care ◽  
Critical Illness ◽  
Mortality Rate ◽  
York City ◽  
Medical Center ◽  
The United States

Background: The first confirmed case of novel coronavirus (2019-nCoV) infection in the United States was reported from the state of Washington in January, 2020. By March, 2020, New York City had become the epicenter of the outbreak in the United States. Methods: We tracked all patients with confirmed coronavirus-19 (COVID-19) infection admitted to intensive care units (ICU) at Montefiore Medical Center (Bronx, NY). Data were obtained through manual review of electronic medical records. Patients had at least 30 days of follow-up. Results: Our first 300 ICU patients were admitted March 10 through April 11, 2020. The majority (60.7%) of patients were men. Acute respiratory distress syndrome (ARDS) was documented in 91.7% of patients; 91.3% required mechanical ventilation. Prone positioning was employed in 58% of patients and neuromuscular blockade in 47.8% of mechanically-ventilated patients. Neither intervention was associated with decreased mortality. Vasopressors were required in 77.7% of patients. Acute kidney injury (AKI) was present on admission in 40.7% of patients, and developed subsequently in 36.0%; 50.9% of patients with AKI received renal replacement therapy (RRT). Overall 30-day mortality rate was 52.3%, and 55.8% among patients receiving mechanical ventilation. In univariate analysis, higher mortality rate was associated with increasing age, male sex, hypertension, obesity, smoking, number of comorbidities, AKI on presentation, and need for vasopressor support. A representative multivariable model for 30-day mortality is also presented, containing patient age, gender, body mass index, and AKI at admission. As of May 11, 2020, 2 patients (0.7%) remained hospitalized. Conclusions: Mortality in critical illness associated with COVID-19 is high. The majority of patients develop ARDS requiring mechanical ventilation, vasopressor-dependent shock, and AKI. The variation in mortality rates reported to date likely reflects differences in the severity of illness of the evaluated populations.

scholarly journals The COVID Army: Experiences from the Deployment of Non-Hospitalist Physician Volunteers during the 2020 COVID Pandemic

2021 ◽  
pp. 1-15
Author(s):  
Kevin Hauck ◽  
Katherine Hochman ◽  
Mark Pochapin ◽  
Sondra Zabar ◽  
Jeffrey A Wilhite ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Medical Center ◽  
The United States ◽  
Lessons Learned ◽  
Front Line ◽  
Clinical Leadership ◽  
Team Members ◽  
Medical Centers ◽  
Hospitalist Physician

Abstract Objective New York City was the epicenter of the outbreak of the 2020 COVID-19 pandemic in the United States. As a large, quaternary care medical center, NYU Langone Medical Center was one of many New York medical centers that experienced an unprecedented influx of patients during this time. Clinical leadership effectively identified, oriented, and rapidly deployed a “COVID Army”, consisting of non-hospitalist physicians, to meet the needs of this patient influx. We share feedback from our providers on our processes and offer specific recommendations for systems experiencing a similar influx in the current and future pandemics. Methods In order to assess the experiences and perceived readiness of these physicians (n=183), we distributed a 32-item survey between March and June of 2020. Thematic analyses and response rates were examined in order to develop results. Results Responses highlighted varying experiences and attitudes of our front-line physicians during an emerging pandemic. Thematic analyses revealed a series of lessons learned, including the need to: (1) provide orientations, (2) clarify roles/ workflow, (3) balance team workload, (4) keep teams updated on evolving policies, (5) make team members feel valued, and (6) ensure they have necessary tools available. Conclusions Lessons from our deployment and assessment are scalable at other institutions.

scholarly journals Evolving oxygenation management reasoning in COVID-19

Diagnosis ◽  
2020 ◽  
Vol 7 (4) ◽  
pp. 381-383
Author(s):  
Steven Liu ◽  
Cara Sweeney ◽  
Nalinee Srisarajivakul-Klein ◽  
Amanda Klinger ◽  
Irina Dimitrova ◽  
...  
Keyword(s):  
United States ◽  
Intensive Care Unit ◽  
New York ◽  
New York City ◽  
Intensive Care ◽  
Initial Phase ◽  
The United States ◽  
Lessons Learned ◽  
Hypoxemic Respiratory Failure ◽  
Hospital Wards

AbstractThe initial phase of the SARS-CoV-2 pandemic in the United States saw rapidly-rising patient volumes along with shortages in personnel, equipment, and intensive care unit (ICU) beds across many New York City hospitals. As our hospital wards quickly filled with unstable, hypoxemic patients, our hospitalist group was forced to fundamentally rethink the way we triaged and managed cases of hypoxemic respiratory failure. Here, we describe the oxygenation protocol we developed and implemented in response to changing norms for acuity on inpatient wards. By reflecting on lessons learned, we re-evaluate the applicability of these oxygenation strategies in the evolving pandemic. We hope to impart to other providers the insights we gained with the challenges of management reasoning in COVID-19.

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