Clinical features and medical care factors associated with mortality in French nursing homes during the COVID-19 outbreak. (March 2021)

• Record Type: Journal Article
• Authors: Tarteret, Paul; Strazzulla, Alessio; Rouyer, Maxence; Gore, Cecile; Bardin, Guillaume; Noel, Coralie; Benguerdi, Zine-Eddine; Berthaud, Julien; Hommel, Manuel; Aufaure, Sylvie; Jochmans, Sebastien; Diamantis, Sylvain
• Is Part Of: International journal of infectious diseases. Volume 104(2021)
• Page Start: 125
• Page End: 131
• Publication Date: 2021-03
• Subjects: Case fatality rate -- Confinement disease -- Standards of care; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2020.12.004
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Mortality rates were highly variable among nursing homes with COVID-19 cases. Hospital-dependent nursing homes were associated with lower mortality rates. Increased material, human and medical resources reduced mortality in nursing homes. Daily clinical examination by a physician reduced mortality in COVID-19 nursing home patients. Abstract: Objectives: This study aimed to identify demographic, clinical and medical care factors associated with mortality in three nursing homes in France. Methods: Two nursing homes were hospital-dependent, had connections with infection prevention and control departments, and had permanent physicians. A third nursing home had no direct connection with a general hospital, no infection control practitioner, and no permanent physician. The main outcome was death. Results: During the first 3 months of the outbreak, 224 of 375 (59.7%) residents were classified as COVID-19 cases and 57 of 375 (15.2%) died. The hospital-dependent nursing homes had lower COVID-19 case fatality rates in comparison with the non-hospital-dependent nursing home (15 [6.6%] vs 38 [25.8%], OR 0.20 [0.11–0.38], p = 0.001). During the first 3 weeks of the outbreak, mortality in COVID-19 patients decreased if they had a daily clinical examination (OR: 0.09 [0.03–0.35], p = 0.01), three vital signs measurement per day (OR: 0.06 [0.01–0.30], p = 0.001) and prophylactic anticoagulation (OR: 0 [0.00–0.24], p = 0.001). Conclusions: This study suggested that high mortality rates in some nursing homes during the COVID-19 outbreak might have been contributed by a lack of medical care management. Increasing human and material resources, encouraging presence of nursing home physicians and establishing a connection with general hospitals should be considered to deal with present and future health disasters in nursing homes.