Abstract:
BACKGROUND:The coronavirus disease 2019 (COVID-19) pandemic continues to surge in the United States and globally. OBJECTIVE:To describe the epidemiology of COVID-19-related critical illness, including trends in outcomes and care delivery. DESIGN:Single-health system, multihospital retrospective cohort study. SETTING:5 hospitals within the University of Pennsylvania Health System. PATIENTS:Adults with COVID-19-related critical illness who were admitted to an intensive care unit (ICU) with acute respiratory failure or shock during the initial surge of the pandemic. MEASUREMENTS:The primary exposure for outcomes and care delivery trend analyses was longitudinal time during the pandemic. The primary outcome was all-cause 28-day in-hospital mortality. Secondary outcomes were all-cause death at any time, receipt of mechanical ventilation (MV), and readmissions. RESULTS:Among 468 patients with COVID-19-related critical illness, 319 (68.2%) were treated with MV and 121 (25.9%) with vasopressors. Outcomes were notable for an all-cause 28-day in-hospital mortality rate of 29.9%, a median ICU stay of 8 days (interquartile range [IQR], 3 to 17 days), a median hospital stay of 13 days (IQR, 7 to 25 days), and an all-cause 30-day readmission rate (among nonhospice survivors) of 10.8%. Mortality decreased over time, from 43.5% (95% CI, 31.3% to 53.8%) to 19.2% (CI, 11.6% to 26.7%) between the first and last 15-day periods in the core adjusted model, whereas patient acuity and other factors did not change. LIMITATION:Single-health system study; use of, or highly dynamic trends in, other clinical interventions were not evaluated, nor were complications. CONCLUSION:Among patients with COVID-19-related critical illness admitted to ICUs of a learning health system in the United States, mortality seemed to decrease over time despite stable patient characteristics. Further studies are necessary to confirm this result and to investigate causal mechanisms. PRIMARY FUNDING SOURCE:Agency for Healthcare Research and Quality.
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Anesi GL,Jablonski J,Harhay MO,Atkins JH,Bajaj J,Baston C,Brennan PJ,Candeloro CL,Catalano LM,Cereda MF,Chandler JM,Christie JD,Collins T,Courtright KR,Fuchs BD,Gordon E,Greenwood JC,Gudowski S,Hanish A,Hanson Iii Cdoi
10.7326/M20-5327subject
Has Abstractpub_date
2021-01-19 00:00:00eissn
0003-4819issn
1539-3704pub_type
杂志文章abstract::Low back pain is common, but a herniated intervertebral disk is the cause in only a small percentage of cases. Most symptomatic disk herniations result in clinical manifestations (pain, reflex loss, muscle weakness) that resolve with conservative therapy, and only 5% to 10% of patients require surgery. Sciatica is usu...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-112-8-598
更新日期:1990-04-15 00:00:00
abstract::For an estimated 10 million trips abroad by U.S. residents in 2002, "visiting friends and relatives" (VFR) was a purpose for travel. Made up largely of foreign-born U.S. residents and their children, this population shows disparities in the number of reported cases of many preventable travel-related illnesses compared...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-142-1-200501040-00013
更新日期:2005-01-04 00:00:00
abstract:OBJECTIVE:To determine whether depressed mood or life events are associated with an exacerbation of inflammatory bowel disease. DESIGN:A prospective study of a consecutive sample of patients with relapsing inflammatory bowel disease, followed by monthly questionnaires and periodic office visits. SETTING:A referral-ba...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-114-5-381
更新日期:1991-03-01 00:00:00
abstract::Cardiovascular disease is the leading cause of death among women in the United States, and stroke is third. This article uses a case scenario to examine female sex-specific cardiovascular risk factors across the lifespan and describes a precision medicine-based approach to risk factor modification and primary preventi...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M19-1601
更新日期:2019-12-03 00:00:00
abstract:BACKGROUND:Lack of confidence in postpolypectomy surveillance guidelines may be a factor in the observed low adherence rates among providers. OBJECTIVE:To assess the 2006 postpolypectomy colonoscopy surveillance guidelines, which recommend 3-year follow-up colonoscopy for individuals with high-risk adenomas (defined a...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.7326/0003-4819-148-6-200803180-00004
更新日期:2008-03-18 00:00:00
abstract::The diagnostic and therapeutic value of the angiotensin converting enzyme inhibitor teprotide (SQ 20881) was assessed in 18 patients with hypertensive emergencies. Mean blood pressure fell 31 +/- 18 mm Hg in the 10 subjects who responded to 1 mg/kg body weight administered intravenously, whereas it fell 5 +/- 3 mm Hg ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-90-1-43
更新日期:1979-01-01 00:00:00
abstract::The prevalence of sleep apnea was studied in 46 middle- and older-aged men with "essential hypertension." Thirty-four age- and weight-similar normotensive men were also studied. Fourteen hypertensive men and three controls had sleep apnea syndrome, as defined as greater than ten apneas per hour of sleep. Hypertensive ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-103-2-190
更新日期:1985-08-01 00:00:00
abstract::A discrete evoking factor or presumed pathophysiologic mechanism is not recognized in the majority of patients with chronic urticaria or angioedema. Two cases are reported in which chronic urticaria was the main manifestation of an immune cutaneous vasculitis associated with hypocomplementemia attributable to classic ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-86-5-534
更新日期:1977-05-01 00:00:00
abstract:OBJECTIVE:To assess the safety and efficacy of intravenous adenosine in terminating acute episodes of paroxysmal supraventricular tachycardia. DESIGN:Two prospective, double-blind, randomized, placebo-controlled trials to evaluate dose response in patients receiving adenosine and to compare the effects of adenosine wi...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.7326/0003-4819-113-2-104
更新日期:1990-07-15 00:00:00
abstract::This paper outlines the clinical, serologic, and immunogenetic differences and similarities of Sjögren's syndrome alone (primary) and Sjögren's syndrome associated with rheumatoid arthritis and systemic lupus erythematosus (secondary). The immunoregulation in Sjögren's syndrome is discussed and the incidence of immune...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-92-2-212
更新日期:1980-02-01 00:00:00
abstract:STUDY OBJECTIVE:To assess the value of a history and physical examination findings in diagnosing the carpal tunnel syndrome, and to determine whether constellations of clinical findings identify patients at high or low risk for the carpal tunnel syndrome. DESIGN:Comparison of diagnostic tests with neurophysiologic tes...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-112-5-321
更新日期:1990-03-01 00:00:00
abstract::Our review focuses on low density lipoprotein (LD lipoprotein) and very low density lipoprotein (VLD lipoprotein) in their roles as transporters of cholesterol and triglyceride and as factors contributing to premature arteriovascular disease. We describe the clinical manifestations of the common, primary hyperlipoprot...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-85-4-497
更新日期:1976-10-01 00:00:00
abstract::Aspirin exerts antiplatelet effects through irreversible inhibition of cyclooxygenase-1, whereas its anticancer effects may be due to inhibition of cyclooxygenase-2 and other pathways. In 2009, the U.S. Preventive Services Task Force endorsed aspirin for primary prevention of cardiovascular disease. However, aspirin's...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M17-2162
更新日期:2017-12-05 00:00:00
abstract:OBJECTIVE:To review the incidence of reversible renal insufficiency in patients with hypertensive nephrosclerosis undergoing antihypertensive therapy. DESIGN:Retrospective analysis of 73 patients in a long-term blood pressure control study that compared the effects of an angiotensin converting enzyme (ACE) inhibitor p...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-115-7-513
更新日期:1991-10-01 00:00:00
abstract::To determine the relative sensitivity and specificity of noninvasive methods for detecting aortic insufficiency, we compared the accuracy of auscultation, echocardiography, and pulsed Doppler echocardiography in detecting aortic insufficiency in 106 patients in whom the presence or absence of the lesion was shown by s...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-104-5-599
更新日期:1986-05-01 00:00:00
abstract:BACKGROUND:Use of proton-pump inhibitors in the management of peptic ulcer bleeding is controversial because discrepant results have been reported in different ethnic groups. OBJECTIVE:To determine whether intravenous esomeprazole prevents recurrent peptic ulcer bleeding better than placebo in a multiethnic patient sa...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.7326/0003-4819-150-7-200904070-00105
更新日期:2009-04-07 00:00:00
abstract:PURPOSE:Cost-utility analysis is a type of cost-effectiveness analysis in which health effects are measured in terms of quality-adjusted life-years (QALYs) gained. Such analyses have become popular for examining the health and economic consequences of health and medical interventions, and they have been recommended by ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-132-12-200006200-00007
更新日期:2000-06-20 00:00:00
abstract:STUDY OBJECTIVE:To determine the efficacy of continuous intravenous infusion of prostacyclin (epoprostenol) in primary pulmonary hypertension. DESIGN:Randomized trial with 8-week treatment periods and nonrandomized treatment for up to 18 months. SETTING:Four referral centers. PATIENTS:Sequential sample of 24 patient...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-112-7-485
更新日期:1990-04-01 00:00:00
abstract:OBJECTIVE:To evaluate the efficacy and safety of fluconazole for prevention of fungal infections. DESIGN:A randomized, placebo-controlled, double-blind, multicenter trial. PATIENTS:Adults (257) undergoing chemotherapy for acute leukemia. INTERVENTION:Patients were randomly assigned to receive either fluconazole (400...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.7326/0003-4819-118-7-199304010-00003
更新日期:1993-04-01 00:00:00
abstract::For years patients hospitalized with viral hepatitis have been placed in two categories of isolation--enteric precautions and blood precautions. This strategy was based on the inability to differentiate between hepatitis A and B and on the assumption that feces and blood from patients with either type might be infecti...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-91-6-872
更新日期:1979-12-01 00:00:00
abstract::The efficacy of corticosteroid treatment in the prophylaxis of the fat embolism syndrome was evaluated in a prospective, randomized, double-blind study of high-risk patients with long-bone fractures. Using a set of objective diagnostic criteria, we saw a significant difference in the incidence of the syndrome between ...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-99-4-438
更新日期:1983-10-01 00:00:00
abstract::Visual loss from the complications of advanced diabetic retinopathy now can be managed more effectively by surgical vitrectomy with a significant reduction in operative and postoperative ocular morbidity. Ocular structures are now maintained in a more normal physiologic state, leaving the patient's lens in place, help...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-99-4-562
更新日期:1983-10-01 00:00:00
abstract:BACKGROUND:Persons with abdominal aortic aneurysm are more likely to have a higher prevalence of risk factors for and clinical manifestations of cardiovascular disease. It is unknown whether these factors explain the high mortality rate associated with abdominal aortic aneurysm. OBJECTIVE:To describe the risk for mort...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-134-3-200102060-00008
更新日期:2001-02-06 00:00:00
abstract:STUDY OBJECTIVE:To assess the effect of weight-bearing exercise training and subsequent detraining on lumbar bone mineral content in postmenopausal women. DESIGN:Non-randomized, controlled, short-term (9 months) trial and long-term (22 months) exercise training and detraining (13 months). SETTING:Section of applied p...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-108-6-824
更新日期:1988-06-01 00:00:00
abstract:BACKGROUND:Impressive decreases in cardiovascular mortality have been achieved through risk factor reduction and clinical intervention, yet cardiovascular disease remains a leading cause of death nationally. OBJECTIVE:To estimate up-to-date preventable fractions of cardiovascular mortality associated with elimination ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M14-1753
更新日期:2015-08-18 00:00:00
abstract:BACKGROUND:Liver transplantation holds promise as a treatment for familial amyloid polyneuropathy. OBJECTIVE:To determine whether peripheral nerves regenerate in patients with familial amyloid polyneuropathy after liver transplantation. DESIGN:Case report. SETTING:University hospital in Matsumoto, Japan. PATIENT:A ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-127-8_part_1-199710150-00006
更新日期:1997-10-15 00:00:00
abstract:BACKGROUND:Pharmaceutical companies and other trial sponsors must submit certain trial results to ClinicalTrials.gov. The validity of these results is unclear. PURPOSE:To validate results posted on ClinicalTrials.gov against publicly available U.S. Food and Drug Administration (FDA) reviews on Drugs@FDA. DATA SOURCES...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M15-2658
更新日期:2016-09-20 00:00:00
abstract::Medical professional codes have long prohibited physician involvement in assisting a patient's suicide. However, despite ethical and legal prohibitions, calls for the liberalization of this ban have grown in recent years. The medical profession should articulate its views on the arguments for and against changes in pu...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-135-3-200108070-00015
更新日期:2001-08-07 00:00:00
abstract::Flecainide acetate has a recognized proarrhythmic effect in patients treated for ventricular tachycardia. Three patients developed severe ventricular arrhythmias while taking flecainide for atrial fibrillation. Patient 1 had normal ventricular function and idiopathic atrial fibrillation. Treadmill exercise tests durin...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-111-2-107
更新日期:1989-07-15 00:00:00
abstract::Although the efficacy of hepatitis vaccine is well documented, the duration of immunity of healthy adults after vaccination is unknown. We studied 245 hospital employees 3 years after primary vaccination with hepatitis B vaccine to determine the prevalence of immunity indicated by levels of antibody to hepatitis B sur...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-108-2-185
更新日期:1988-02-01 00:00:00