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Characterization and clinical course of 1000 patients with coronavirus disease 2019 in New York: retrospective case series.
BMJ. 2020 05 29; 369:m1996.BMJ

Abstract

OBJECTIVE

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.

SETTING

NewYork-Presbyterian/Columbia University Irving Medical Center, a quaternary care academic medical center in New York City.

PARTICIPANTS

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.

MAIN OUTCOME MEASURES

Characterization of patients, including demographics, presenting symptoms, comorbidities on presentation, hospital course, time to intubation, complications, mortality, and disposition.

RESULTS

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.

CONCLUSIONS

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.

Authors+Show Affiliations

Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA. Department of Biomedical Informatics, Columbia University Irving Medical Center, 622 West 168th Street, PH-20, New York, NY 10032, USA.Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA. Department of Biomedical Informatics, Columbia University Irving Medical Center, 622 West 168th Street, PH-20, New York, NY 10032, USA.Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA. Department of Biomedical Informatics, Columbia University Irving Medical Center, 622 West 168th Street, PH-20, New York, NY 10032, USA.Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA. Department of Biomedical Informatics, Columbia University Irving Medical Center, 622 West 168th Street, PH-20, New York, NY 10032, USA.Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA.Division of General Medicine, Department of Medicine, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA.Department of Emergency Medicine, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA.Division of Cardiology, Department of Medicine, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA.Department of Medicine, Weill Cornell Medicine, New York, NY, USA.Department of Emergency Medicine, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA.Department of Medicine, Weill Cornell Medicine, New York, NY, USA.Department of Emergency Medicine, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA.Division of General Medicine, Department of Medicine, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA.Department of Emergency Medicine, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA.Department of Medicine, Weill Cornell Medicine, New York, NY, USA.Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA.Department of Biomedical Informatics, Columbia University Irving Medical Center, 622 West 168th Street, PH-20, New York, NY 10032, USA.Division of Infectious Diseases, Department of Medicine, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA.Division of Infectious Diseases, Department of Medicine, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA.Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.Department of Biomedical Informatics, Columbia University Irving Medical Center, 622 West 168th Street, PH-20, New York, NY 10032, USA.Department of Biomedical Informatics, Columbia University Irving Medical Center, 622 West 168th Street, PH-20, New York, NY 10032, USA.Department of Biomedical Informatics, Columbia University Irving Medical Center, 622 West 168th Street, PH-20, New York, NY 10032, USA ruijun.chen@columbia.edu. Department of Medicine, Weill Cornell Medicine, New York, NY, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32471884

Citation

Argenziano, Michael G., et al. "Characterization and Clinical Course of 1000 Patients With Coronavirus Disease 2019 in New York: Retrospective Case Series." BMJ (Clinical Research Ed.), vol. 369, 2020, pp. m1996.
Argenziano MG, Bruce SL, Slater CL, et al. Characterization and clinical course of 1000 patients with coronavirus disease 2019 in New York: retrospective case series. BMJ. 2020;369:m1996.
Argenziano, M. G., Bruce, S. L., Slater, C. L., Tiao, J. R., Baldwin, M. R., Barr, R. G., Chang, B. P., Chau, K. H., Choi, J. J., Gavin, N., Goyal, P., Mills, A. M., Patel, A. A., Romney, M. S., Safford, M. M., Schluger, N. W., Sengupta, S., Sobieszczyk, M. E., Zucker, J. E., ... Chen, R. (2020). Characterization and clinical course of 1000 patients with coronavirus disease 2019 in New York: retrospective case series. BMJ (Clinical Research Ed.), 369, m1996. https://doi.org/10.1136/bmj.m1996
Argenziano MG, et al. Characterization and Clinical Course of 1000 Patients With Coronavirus Disease 2019 in New York: Retrospective Case Series. BMJ. 2020 05 29;369:m1996. PubMed PMID: 32471884.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Characterization and clinical course of 1000 patients with coronavirus disease 2019 in New York: retrospective case series. AU - Argenziano,Michael G, AU - Bruce,Samuel L, AU - Slater,Cody L, AU - Tiao,Jonathan R, AU - Baldwin,Matthew R, AU - Barr,R Graham, AU - Chang,Bernard P, AU - Chau,Katherine H, AU - Choi,Justin J, AU - Gavin,Nicholas, AU - Goyal,Parag, AU - Mills,Angela M, AU - Patel,Ashmi A, AU - Romney,Marie-Laure S, AU - Safford,Monika M, AU - Schluger,Neil W, AU - Sengupta,Soumitra, AU - Sobieszczyk,Magdalena E, AU - Zucker,Jason E, AU - Asadourian,Paul A, AU - Bell,Fletcher M, AU - Boyd,Rebekah, AU - Cohen,Matthew F, AU - Colquhoun,MacAlistair I, AU - Colville,Lucy A, AU - de Jonge,Joseph H, AU - Dershowitz,Lyle B, AU - Dey,Shirin A, AU - Eiseman,Katherine A, AU - Girvin,Zachary P, AU - Goni,Daniella T, AU - Harb,Amro A, AU - Herzik,Nicholas, AU - Householder,Sarah, AU - Karaaslan,Lara E, AU - Lee,Heather, AU - Lieberman,Evan, AU - Ling,Andrew, AU - Lu,Ree, AU - Shou,Arthur Y, AU - Sisti,Alexander C, AU - Snow,Zachary E, AU - Sperring,Colin P, AU - Xiong,Yuqing, AU - Zhou,Henry W, AU - Natarajan,Karthik, AU - Hripcsak,George, AU - Chen,Ruijun, Y1 - 2020/05/29/ PY - 2020/5/31/entrez PY - 2020/5/31/pubmed PY - 2020/6/6/medline SP - m1996 EP - m1996 JF - BMJ (Clinical research ed.) JO - BMJ VL - 369 N2 - OBJECTIVE: 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. SETTING: NewYork-Presbyterian/Columbia University Irving Medical Center, a quaternary care academic medical center in New York City. PARTICIPANTS: 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. MAIN OUTCOME MEASURES: Characterization of patients, including demographics, presenting symptoms, comorbidities on presentation, hospital course, time to intubation, complications, mortality, and disposition. RESULTS: 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. CONCLUSIONS: 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. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/32471884/full_citation L2 - http://www.bmj.com/cgi/pmidlookup?view=long&pmid=32471884 DB - PRIME DP - Unbound Medicine ER -