INTRODUCTION: As of December 18, 2020, there have been nearly 17 million cases of COVID-19 in the United States. Early studies reported intubation rates between 12.2-29.2% with varying criteria between sites and as the pandemic has progressed. With the rapid spread of infection and increased use of ventilators, triage of patients based on factors such as their past medical history can help guide resource allocation. This retrospective study examined a large multi-center cohort of patients with COVID-19 infection to identify risk factors associated with intubation. METHODS: Adult patients with an emergency department or inpatient encounter from December 1, 2019 to June 30, 2020 with COVID-19 were included in the Cerner COVID-19 dataset, which was extracted from 62 hospital systems throughout the United States. Only patients with at least two previous visits in the past 5 years were included. ICD-10 diagnosis codes, demographic data, and discharge status were collected and classified based on intubation status. Logistic regression model identified independently associated risk factors for intubation. RESULTS:18,467 patients with confirmed SARS-CoV-2 infection were identified, with 5,525 seen only in the ED and 12,942 hospitalized. The mean age was 54.3 ± 20.5 years, the mean body mass index (BMI) was 30.42 ± 11.72, 8,397 (45.6%) patients were male, and 938 (7.2%) were intubated. 1,829 (14.1%) patients died in the hospital and 4,185 (22.7%) had a non-routine discharge, which encompasses home health care, short-term hospital, other facility including intermediate care and skilled nursing home. Using multivariate logistic regression, patients who were intubated were more likely to present with stroke, pneumonia, acute kidney injury, septic shock, respiratory failure, cardiac arrest, and encephalopathy. From patient demographics and past medical history, male sex (p=0.011), age &gt; 35 (p=0.035 for 35-49 years old;p&lt;0.001 for &gt;50 years old), BMI &gt; 30 (p=0.013 for BMI 30-40;p=0.004 for BMI &gt;40), and previous respiratory failure (p=0.014) were independently associated with intubation. CONCLUSIONS: Among patients with COVID-19, male sex, increased age, BMI &gt; 30, and previous respiratory failure were independently associated with the risk for intubation. Intubated patients were also more likely to present with stroke, pneumonia, acute kidney injury, septic shock, respiratory failure, cardiac arrest, and encephalopathy. Clinicians should be aware of these independent risk factors for intubation to facilitate resource allocation and minimize the possibility of unanticipated crash intubations.
Intubation among emergency department and hospitalized patients with COVID-19: A retrospective analysis of 18,467 patients