The likelihood of admission to an intensive care bed dramatically decreased in elderly patients during the first wave of the COVID-19 pandemic in Spain

Abstract

Background During the first wave of the COVID-19 pandemic, the availability of mechanical ventilators was very limited and ad hoc recommendations establishing age to be used for patient triage for having access to intensive care beds (ICBs) were proposed. No reports have evaluated how this policy impacted ICB admission in Western countries.

Aims We analyzed the age-related probability of ICB admission during first COVID-19 pandemic wave.

Materials and Methods We included all patients ≥65 years attended in 42 Spanish emergency departments (EDs) covering around 22% of the Spanish population during 1-week of the first wave of the COVID-19 pandemic (9128 ED visits) and compared the probability of ICB admission respect to patients coming to these EDs 1-week of 1-year earlier (24,128 ED visits).

Results We found that compared with patients aged 65, the probability of ICB admission was significantly reduced from 79 years and up during the pandemic period (odds ratio [OR] = 0.60 for patients aged 79, 95% confidence interval [CI] = 0.39–0.94), while a significant reduction of ICB admission probabilities was found from 88 years and up during the pre-COVID-19 period (OR = 0.66 for patients aged 88, 95% CI = 0.45–0.95) (p < 0.001 for interaction). Similar results were found when analyses were limited to hospitalized or deceased patients and also after adjustment using sex and several baseline status covariates.

Conclusion There was a real limitation in clinical practice of ICB admission based on age during the first wave of the COVID-19 pandemic.