Abstract
BackgroundIn most countries, the official statistics for the coronavirus disease 2019 (COVID-19) take account of in-hospital deaths but not those that occur at home. The study’s objective was to introduce a methodology to assess COVID-19 home deaths by analysing the French national out-of-hospital cardiac arrest (OHCA) registry (RéAC).MethodsWe performed a retrospective multicentre cohort study based on data recorded in the RéAC by 20 mobile medical teams (MMTs) between March 1st and April 15th, 2020. The participating MMTs covered 10.1% of the French population. OHCA patients were classified as probable or confirmed COVID-19 cases or as non-COVID-19 cases. To achieve our primary objective, we computed the incidence and survival at hospital admission of cases of COVID-19 OHCA occurring at home. Cardiac arrests that occurred in retirement homes or public places were excluded. Hence, we estimated the number of at-home COVID-19-related deaths that were not accounted for in the French national statistics.ResultsWe included 670 patients with OHCA. The extrapolated annual incidence of OHCA per 100,000 inhabitants was 91.9 overall and 17.6 for COVID-19 OHCA occurring at home. In the latter group, the survival rate after being taken to the hospital after an OHCA was 10.9%. We estimated that 1322 deaths were not accounted in the French national statistics on April 15, 2020.ConclusionsThe ratio of COVID-19 out-of-hospital deaths to in-hospital deaths was 12.4%, and so the national statistics underestimated the death rate.
Highlights
In most countries, the official statistics for the coronavirus disease 2019 (COVID-19) take account of inhospital deaths but not those that occur at home
Healthcare professionals have noticed that a patient’s condition sometimes deteriorates very quickly. It is not known how often COVID-19 patients die as a result of an acute clinical deterioration that starts at home, i.e. before they are admitted to the emergency room or even before a mobile medical team (MMT) arrives
The population was predominantly male (68.8%), and there was a significant difference between the COVID-19 and nonCOVID-19 groups (60.3% vs. 71.2% males, respectively; odds ratio and 95% confidence intervals (OR [95%CI]) 0.61 [0.41;0.92], p = 0.015)
Summary
The official statistics for the coronavirus disease 2019 (COVID-19) take account of inhospital deaths but not those that occur at home. The severity of the coronavirus disease 2019 (COVID19) is directly related to resulting health complications like severe acute respiratory syndrome, septic shock, sepsis, and cardiac, thrombotic or thromboembolic disorders [1,2,3,4,5,6,7] These complications can lead to out-ofhospital cardiac arrest (OHCA) when patients are not Hubert et al BMC Medical Research Methodology (2020) 20:305 jump in the total COVID-19-related death count in France. The present study’s objective was to introduce a methodology to assess the number of COVID-19 patients who die at home To this end, we analysed data from the French national out-ofhospital cardiac arrest (OHCA) registry (RéAC) [12]
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