Regional differences in triage decisions affect hospital mortality among frail COVID-19 patients in the COvid MEdicaTion study
Abstract Objectives The scarcity of intensive care unit (ICU) beds during the COVID-19 pandemic has led to a large number of national and international guidelines for the triage of ICU admission. Regional variation in medical decision making might affect ICU triage decisions. We investigate whether...
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| Format: | Article |
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BMC
2025-02-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | https://doi.org/10.1186/s12879-025-10540-2 |
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| author | Julia Minnema Roos Sablerolles Janneke van Kempen Hugo van der Kuy Harmke Polinder-Bos Bob van de Loo Jorie Versmissen Miriam L. Haaksma Melvin Lafeber Miriam C. Faes on behalf of the COMET research team^ |
| author_facet | Julia Minnema Roos Sablerolles Janneke van Kempen Hugo van der Kuy Harmke Polinder-Bos Bob van de Loo Jorie Versmissen Miriam L. Haaksma Melvin Lafeber Miriam C. Faes on behalf of the COMET research team^ |
| author_sort | Julia Minnema |
| collection | DOAJ |
| description | Abstract Objectives The scarcity of intensive care unit (ICU) beds during the COVID-19 pandemic has led to a large number of national and international guidelines for the triage of ICU admission. Regional variation in medical decision making might affect ICU triage decisions. We investigate whether regional differences in ICU admission, as surrogate for triage decisions, affect in-hospital mortality in COVID-19 patients. Methods The COMET study is a multicenter, observational cohort study, including adult patients hospitalized for COVID-19 between March 2020– July 2020. Patients’ characteristics, prescribed medication, clinical characteristics, and CFS were collected. Patients from 11 European countries were included and these countries were categorized into two regions: north and south. The effects of region on ICU admission and in-hospital mortality were assessed using logistic regression analyses stratified for frailty. Results Frail patients had a higher risk for ICU admission in southern compared to northern countries (OR: 1.64; 95%CI: 1.10–2.46), whereas fit patients had a similar risk for ICU admission in southern compared to northern countries (OR: 0.75; 95%CI: 0.55–1.01). There was no difference in in-hospital mortality between northern and southern countries for fit and frail patients (respectively OR: 0.82; 95% CI 0.52–1.29, and OR: 1.11; 95% CI: 0.74–1.66). Conclusion Our study shows that, despite variation in rates of ICU admission between northern and southern countries for frail patients, no difference in in-hospital mortality was observed. This might help optimize prioritization of resources in a pandemic setting while offering options for palliative care instead of ICU admission. |
| format | Article |
| id | doaj-art-d43678456b7f411baa934f4654c176b7 |
| institution | Kabale University |
| issn | 1471-2334 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj-art-d43678456b7f411baa934f4654c176b72025-02-09T12:14:30ZengBMCBMC Infectious Diseases1471-23342025-02-012511510.1186/s12879-025-10540-2Regional differences in triage decisions affect hospital mortality among frail COVID-19 patients in the COvid MEdicaTion studyJulia Minnema0Roos Sablerolles1Janneke van Kempen2Hugo van der Kuy3Harmke Polinder-Bos4Bob van de Loo5Jorie Versmissen6Miriam L. Haaksma7Melvin Lafeber8Miriam C. Faes9on behalf of the COMET research team^Department of Internal Medicine, Erasmus MC, University Medical Center RotterdamDepartment of Hospital Pharmacy, Erasmus MC, University Medical Center RotterdamDepartment of Geriatrics, Amphia HospitalDepartment of Hospital Pharmacy, Erasmus MC, University Medical Center RotterdamDepartment of Internal Medicine, Erasmus MC, University Medical Center RotterdamDigitalis Rx BVDepartment of Internal Medicine, Erasmus MC, University Medical Center RotterdamDepartment of Public Health and Primary Care, Leiden University Medical CentreDepartment of Internal Medicine, Erasmus MC, University Medical Center RotterdamDepartment of Geriatrics, Amphia HospitalAbstract Objectives The scarcity of intensive care unit (ICU) beds during the COVID-19 pandemic has led to a large number of national and international guidelines for the triage of ICU admission. Regional variation in medical decision making might affect ICU triage decisions. We investigate whether regional differences in ICU admission, as surrogate for triage decisions, affect in-hospital mortality in COVID-19 patients. Methods The COMET study is a multicenter, observational cohort study, including adult patients hospitalized for COVID-19 between March 2020– July 2020. Patients’ characteristics, prescribed medication, clinical characteristics, and CFS were collected. Patients from 11 European countries were included and these countries were categorized into two regions: north and south. The effects of region on ICU admission and in-hospital mortality were assessed using logistic regression analyses stratified for frailty. Results Frail patients had a higher risk for ICU admission in southern compared to northern countries (OR: 1.64; 95%CI: 1.10–2.46), whereas fit patients had a similar risk for ICU admission in southern compared to northern countries (OR: 0.75; 95%CI: 0.55–1.01). There was no difference in in-hospital mortality between northern and southern countries for fit and frail patients (respectively OR: 0.82; 95% CI 0.52–1.29, and OR: 1.11; 95% CI: 0.74–1.66). Conclusion Our study shows that, despite variation in rates of ICU admission between northern and southern countries for frail patients, no difference in in-hospital mortality was observed. This might help optimize prioritization of resources in a pandemic setting while offering options for palliative care instead of ICU admission.https://doi.org/10.1186/s12879-025-10540-2COVID-19FrailtyTriagePolicy |
| spellingShingle | Julia Minnema Roos Sablerolles Janneke van Kempen Hugo van der Kuy Harmke Polinder-Bos Bob van de Loo Jorie Versmissen Miriam L. Haaksma Melvin Lafeber Miriam C. Faes on behalf of the COMET research team^ Regional differences in triage decisions affect hospital mortality among frail COVID-19 patients in the COvid MEdicaTion study BMC Infectious Diseases COVID-19 Frailty Triage Policy |
| title | Regional differences in triage decisions affect hospital mortality among frail COVID-19 patients in the COvid MEdicaTion study |
| title_full | Regional differences in triage decisions affect hospital mortality among frail COVID-19 patients in the COvid MEdicaTion study |
| title_fullStr | Regional differences in triage decisions affect hospital mortality among frail COVID-19 patients in the COvid MEdicaTion study |
| title_full_unstemmed | Regional differences in triage decisions affect hospital mortality among frail COVID-19 patients in the COvid MEdicaTion study |
| title_short | Regional differences in triage decisions affect hospital mortality among frail COVID-19 patients in the COvid MEdicaTion study |
| title_sort | regional differences in triage decisions affect hospital mortality among frail covid 19 patients in the covid medication study |
| topic | COVID-19 Frailty Triage Policy |
| url | https://doi.org/10.1186/s12879-025-10540-2 |
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