Covid-19

The intensive care population profile in Denmark before and during the first wave of the SARS-CoV-2 pandemic; a national register-based study

Original Articles, Volume 23, Issue 2, Pages 53 – 96 (2024)

Objective: To describe the change in admission rate and demographic profile of patients admitted to ICUs throughout Denmark before and during first wave of the SARS-CoV-2 pandemic.
Methods: A register-based national observational study of all patients admitted to ICU from December 2019 until April 2020, comparing ICU admission before and after lockdown.
Results: The number of admissions declined, especially in the age groups below 18 and above 70. The sex distribution and the comorbidity-level remained unchanged. The length of hospital stay prior to ICU admission increased. Overall fewer patients were admitted electively.
Conclusion: Fewer patients were admitted to ICU and waited longer for admission during the first wave of the COVID-19 pandemic.

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Guest Editorial – Shifting Dynamics: ICU Admissions in Denmark during the First Wave of the COVID-19 Pandemic

Guest Editorial, Volume 23, Issue 2, Pages 53 – 96 (2024)

The advent of the SARS-CoV-2 pandemic brought unprecedented challenges to healthcare systems worldwide. As the virus spread across continents, hospitals faced a surge in patient admissions, particularly to intensive care units (ICUs). Understanding the impact of the pandemic on the sickest patients admitted to hospital is crucial for enhancing preparedness for future outbreaks. In this edition of the journal, authors from Denmark report on a register-based national observational study that sheds light on the changes in ICU admission rates and demographic profiles of patients during the initial phase of the pandemic.

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A whole healthcare system mortality review of the second wave COVID-19 pandemic response, were lessons learned?

Original Articles, Volume 22, Issue 1, Pages 1 – 56 (2023)

We previously reported a study of features of emergency healthcare response to COVID-19 that could be modified to mitigate against future excess deaths. Here we determined what themes persisted in later waves.
This was an expert panel review of all components of care delivered to COVID-19 patients who died (primary and secondary care, community services, NHS 111 and 999, COVID oximetry at home, virtual wards).
174 deaths were included. 5% were deemed >50% avoidable, 75% included avoidability themes.
Contact with primary care remains mostly via telephone, creating diagnostic risk. Patient decision to avoid healthcare contact was common.
Recommendations include: better utilisation of home monitoring in future pandemics; improved avoidance of nosocomial spread; patients be encouraged to seek medical advice earlier.

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Guest Editorial – Curry clubs, uncertain times, and social media

Guest Editorial, Volume 21, Issue 3, Pages 121-164 (2022)

COVID-19, the eternal hospital winter, heatwaves, global warming, energy costs, inflation, and an unnecessary war. We truly do live in uncertain times. That said, we would wager our grandparents said the same thing. What gets us through is family, friends and out shared communities, including acute medicine. Which brings us to this edition of the journal, where many excellent articles will hopefully distract our reader from all the doom and gloom, and instead light up your grey cells.

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Tocilizumab for treatment of SARS-CoV-2 infection at home: A case report

Case Reports, Volume 21, Issue 1, Pages 1-64 (2022)

SARS-CoV-2 virtual wards have successfully developed to monitor and escalate patients to hospital throughout the pandemic. Here we describe the case of an 84 year old man who received his complete care for severe SARS-CoV-2 pneumonitis at home, including the administration of oxygen, dexamethasone and tocilizumab.

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The Diagnostic Accuracy and Prognostic Value of Lung ultrasound in Suspected COVID-19 a retrospective service evaluation

Correspondence, Volume 21, Issue 1, Pages 1-64 (2022)

We read with interest the paper from Knight et al in Acute Medicine in particular the use of a lung ultrasound (LUS) score to predict outcome in patients with suspected COVID-19. LUS has been shown to be useful in the diagnosis and prognosis for COVID-19 by other authors. We have carried out a service evaluation project on our data from East Surrey Hospital looking into prognostic and diagnostic performance of LUS in suspected COVID-19. In contrast to the data used by Knight et al we had discharge diagnosis data available which allowed us to split the cohort into patients with COVID-19 and patients with other diagnoses and compare the LUS score between the two groups.

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The experiences of NHS hospital acute medicine departments in England during the first wave of the COVID-19 pandemic

Original Articles, Volume 20, Issue 3, Pages 157-248 (2021)

We conducted a survey exploring the experiences of NHS hospital acute medicine services in England during the 1st wave of the COVID-19 pandemic. Responses were collected from 26th May to 8th July 2020. The results of 91 sites are presented. The total number of patients referred to the medical take for assessment and admitted from the medical take decreased from pre-pandemic levels compared to peak COVID-19 activity. The total number of acute medical beds decreased, however critical care beds increased by 162%. We report the median timeline from first admission of COVID-19 to when baseline critical care capacity was reached. We found regional variation across the results. These findings can assist healthcare leaders prepare for future pandemics.

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A case report of extensive cerebral venous sinus thrombosis: a sequela of COVID-19?

Case Reports, Volume 20, Issue 3, Pages 157-248 (2021)

Coronavirus disease 2019 (COVID-19) is an infectious respiratory disease that is often the trigger for thrombotic complications. Cerebral venous sinus thrombosis (CVST) represents a small percentage of strokes, frequently proving to be a diagnostic challenge. We report a 31-year-old lady presenting with a persistent headache, 18 weeks after a mild COVID-19 illness. On her second visit, CT venography revealed extensive CVST. She was commenced on low-molecular-weight heparin, and was monitored closely in the neuro-medical intensive care unit. She was discharged 2 weeks later, with no residual neurological deficit, and commenced on a direct oral anticoagulant in the community. CVST should be considered in patients presenting with a refractory headache, with greater suspicion if previously infected with SARS-CoV-2.

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Thrombotic thrombocytopenia following ChAdOx1 nCov-19 vaccination

Case Reports, Volume 20, Issue 3, Pages 157-248 (2021)

Serious thromboembolic events with concurrent thrombocytopenia, sometimes accompanied by bleeding, have occurred very rarely following administration of the ChAdOx1 nCoV-19 vaccine. We report the case of a 59-year-old male with an unremarkable medical history who presented to the emergency department with increasing breathlessness five days after receiving the first dose of ChAdOx1 nCov-19. The patient’s blood results showed mild thrombocytopenia and a very high D-dimer, and a pulmonary embolism was confirmed through a CT pulmonary angiogram, which led to a provisional diagnosis of vaccine-induced immune thrombotic thrombocytopenia. The condition was then treated with immunoglobulin and intravenous argatroban in line with the guidance from the Expert Haematology Panel focussed on Vaccine-induced Thrombosis and Thrombocytopenia before conversion to apixaban.

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D-dimer levels for Risk Stratification in Patients with Suspected COVID-19 – A Prospective Observational Study

Original Articles, Volume 20, Issue 3, Pages 157-248 (2021)

Background: Elevated D-dimer levels have been observed in COVID-19 and are of prognostic value, but have not been compared to an appropriate control group.
Methods: Observational cohort study including emergency patients with suspected or confirmed COVID-19. Logistic regression defined the association of D-dimer levels, COVID-19 positivity, age, and gender with 30-day-mortality.
Results: 953 consecutive patients (median age 58, 43% women) presented with suspected COVID-19: 12 (7.4%) patients with confirmed SARS-CoV-2-infection died, compared with 28 (3.5%) patients without SARS-CoV-2-infection. Overall, most (56%) patients had elevated D-dimer levels (≥0.5mg/l). Age (OR 1.07, CI 1.05-1.10), D-dimer levels ≥0.5mg/l (OR 2.44, CI 0.98-7.39), and COVID-19 (OR 2.79, CI 1.28-5.80) were associated with 30-day-mortality.
Conclusion: D-dimer levels are effective prognosticators in both patient groups.

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