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- Title
Trends in Severe Outcomes Among Adult and Pediatric Patients Hospitalized With COVID-19 in the Canadian Nosocomial Infection Surveillance Program, March 2020 to May 2022.
- Authors
Mitchell, Robyn; Cayen, Joelle; Thampi, Nisha; Frenette, Charles; Bartoskzo, Jessica; Choi, Kelly Baekyung; Comeau, Jeannette L.; Conly, John; Ellis, Chelsey; Ellison, Jennifer; Embil, John; Evans, Gerald; Johnston, Lynn; Johnstone, Jennie; Katz, Kevin C.; Kibsey, Pamela; Lee, Bonita; Lefebvre, Marie-Astrid; Longtin, Yves; McGeer, Allison
- Abstract
Key Points: Question: What are the trends in severe outcomes among adult and pediatric patients hospitalized with laboratory-confirmed COVID-19 during the first 2 years of the COVID-19 pandemic? Findings: In a cohort study of 55 714 adult and pediatric patients hospitalized with laboratory-confirmed COVID-19 in 155 acute care hospitals in Canada, surveillance data show that during waves 5 and 6 of the COVID-19 pandemic, hospitals experienced a surge in patients hospitalized with COVID-19, an increase in nosocomial transmission of COVID-19, and a decrease in severe outcomes. Meaning: These findings suggest that despite a reduction in severe outcomes in waves 5 and 6, the burden of COVID-19 on Canadian hospitals was substantial. This cohort study describes trends in severe outcomes among patients hospitalized with COVID-19 from March 2020 to May 2022 in the Canadian Nosocomial Infection Surveillance Program. Importance: Trends in COVID-19 severe outcomes have significant implications for the health care system and are key to informing public health measures. However, data summarizing trends in severe outcomes among patients hospitalized with COVID-19 in Canada are not well described. Objective: To describe trends in severe outcomes among patients hospitalized with COVID-19 during the first 2 years of the COVID-19 pandemic. Design, Setting, and Participants: Active prospective surveillance in this cohort study was conducted from March 15, 2020, to May 28, 2022, at a sentinel network of 155 acute care hospitals across Canada. Participants included adult (aged ≥18 years) and pediatric (aged 0-17 years) patients hospitalized with laboratory-confirmed COVID-19 at a Canadian Nosocomial Infection Surveillance Program (CNISP)–participating hospital. Exposures: COVID-19 waves, COVID-19 vaccination status, and age group. Main Outcomes and Measures: The CNISP collected weekly aggregate data on the following severe outcomes: hospitalization, admission to an intensive care unit (ICU), receipt of mechanical ventilation, receipt of extracorporeal membrane oxygenation, and all-cause in-hospital death. Results: Among 1 513 065 admissions, the proportion of adult (n = 51 679) and pediatric (n = 4035) patients hospitalized with laboratory-confirmed COVID-19 was highest in waves 5 and 6 of the pandemic compared with waves 1 to 4 (77.3 vs 24.7 per 1000 patient admissions). Despite this, the proportion of patients with positive test results for COVID-19 who were admitted to an ICU, received mechanical ventilation, received extracorporeal membrane oxygenation, and died were each significantly lower in waves 5 and 6 when compared with waves 1 through 4. Admission to the ICU and in-hospital all-cause death rates were significantly higher among those who were unvaccinated against COVID-19 when compared with those who were fully vaccinated (incidence rate ratio, 4.3 and 3.9, respectively) or fully vaccinated with an additional dose (incidence rate ratio, 12.2 and 15.1, respectively). Conclusions and Relevance: The findings of this cohort study of patients hospitalized with laboratory-confirmed COVID-19 suggest that COVID-19 vaccination is important to reduce the burden on the Canadian health care system as well as severe outcomes associated with COVID-19.
- Subjects
CANADA; PUBLIC health surveillance; EVALUATION of medical care; COVID-19; HUMAN research subjects; IMMUNIZATION; CONFIDENCE intervals; CROSS infection; PATIENT readmissions; EXTRACORPOREAL membrane oxygenation; INFORMED consent (Medical law); ARTIFICIAL respiration; T-test (Statistics); HOSPITAL care; DESCRIPTIVE statistics; DATA analysis software; ODDS ratio; HOSPITAL care of children; COVID-19 pandemic
- Publication
JAMA Network Open, 2023, Vol 6, Issue 4, pe239050
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.9050