Characterization and clinical course of 1000 patients with coronavirus disease 2019 in New York: retrospective case series
Michael G Argenziano, Samuel L Bruce, Cody L Slater, Jonathan R Tiao, Matthew R Baldwin, R Graham Barr, Bernard P Chang, Katherine H Chau, Justin J Choi, Nicholas Gavin, Parag Goyal, Angela M Mills, Ashmi A Patel, Marie-Laure S Romney, Monika M Safford, Neil W Schluger, Soumitra Sengupta, Magdalena E Sobieszczyk, Jason E Zucker, Paul A Asadourian, Fletcher M Bell, Rebekah Boyd, Matthew F Cohen, Macalistair I Colquhoun, Lucy A Colville, Joseph H De Jonge, Lyle B Dershowitz, Shirin A Dey, Katherine A Eiseman, Zachary P Girvin, Daniella T Goni, Amro A Harb, Nicholas Herzik, Sarah Householder, Lara E Karaaslan, Heather Lee, Evan Lieberman, Andrew Ling, Ree Lu, Arthur Y Shou, Alexander C Sisti, Zachary E Snow, Colin P Sperring, Yuqing Xiong, Henry W Zhou, Karthik Natarajan, George Hripcsak, Ruijun Chen
BMJ, doi:10.1136/bmj.m1996
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.
We wish to acknowledge the dedication, commitment, and sacrifice of the staff, providers and personnel at our institutions through the local covid-19 crisis and express our profound sadness about the suffering and loss of our patients, their families, and our community. We would also like to express our gratitude to the patients whose records were used in this study, without whom this research would not be possible. Finally, we would like to acknowledge the Weill Cornell Medicine COVID-19 Registry Team, which developed the chart abstraction tool used in this study and assisted with training of the VP&S medical students in the chart abstraction process. Data sharing: Requests for the statistical code and dataset can be made to the corresponding author.
Contributors The corresponding author affirms that the manuscript is an honest, accurate, and transparent account of the study being reported. No important aspects of the study have been omitted, and all discrepancies from the study as planned have been explained. Dissemination to participants and related patient and public communities: We disseminated the findings of this study to all clinical departments caring for patients with covid-19 at authoraffiliated institutions. In addition, our media relations departments will plan to further disseminate through press releases, social media, and on institutional web sites upon publication. Web appendix: Supplementary appendix
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doi:10.1016/S0140-6736(20)30566-3{ 'indexed': {'date-parts': [[2024, 7, 21]], 'date-time': '2024-07-21T06:30:17Z', 'timestamp': 1721543417584},
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'abstract': '<jats:title>Abstract</jats:title>\n'
' <jats:sec>\n'
' <jats:title>Objective</jats:title>\n'
' <jats:p>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.</jats:p>\n'
' </jats:sec>\n'
' <jats:sec>\n'
' <jats:title>Design</jats:title>\n'
' <jats:p>Retrospective manual medical record review.</jats:p>\n'
' </jats:sec>\n'
' <jats:sec>\n'
' <jats:title>Setting</jats:title>\n'
' <jats:p>NewYork-Presbyterian/Columbia University Irving Medical Center, a '
'quaternary care academic medical center in New York City.</jats:p>\n'
' </jats:sec>\n'
' <jats:sec>\n'
' <jats:title>Participants</jats:title>\n'
' <jats:p>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.</jats:p>\n'
' </jats:sec>\n'
' <jats:sec>\n'
' <jats:title>Main outcome measures</jats:title>\n'
' <jats:p>Characterization of patients, including demographics, presenting '
'symptoms, comorbidities on presentation, hospital course, time to intubation, complications, '
'mortality, and disposition.</jats:p>\n'
' </jats:sec>\n'
' <jats:sec>\n'
' <jats:title>Results</jats:title>\n'
' <jats:p>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.</jats:p>\n'
' </jats:sec>\n'
' <jats:sec>\n'
' <jats:title>Conclusions</jats:title>\n'
' <jats:p>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.</jats:p>\n'
' </jats:sec>',
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