The impact of COVID-19 pandemic on decision and diagnostic making process in non-COVID-19 patients: A retrospective comparative study.

Abstract

Introduction: The COVID-19 pandemic has been challenging and has affected non-COVID-19 patients to some extent. In this study, we aim to illustrate the impact of the COVID-19 pandemic on the decision and diagnostic making processes, management, and outcomes in non-COVID-19 patients.

Methods: A retrospective, comparative observational monocentric study with historical control, carried out in a 12-bed medical intensive care unit (ICU) between March 9, 2020, and May 30, 2020. All non-COVID-19 patients were included. Patients’ demographics, clinical characteristics, diagnoses before ICU, at admission, and diagnostic discrepancies, specific delays, management, and outcomes were collected. The impact on patients’ clinical state was assessed using a predefined grading scale describing the severity of diagnostic and management discrepancies. Patients included were compared to those admitted during the same period one year prior.

Results: During the two-month study period, 57 patients were referred to the ICU; 12(21%), COVID-19 and 45(79%) non-COVID-19 patients. Compared to the same period last year, the number of non-COVID-19 admissions was lower, 45 in 2020 vs 74 in 2019. Patients admitted during the pandemic received less noninvasive ventilation (NIV); 11(24.4%) vs 40(54.1%), p=0.009; and had shorter length of stay (LOS); 4[3-10.5] days vs 8[5-13] days, p=0.04. Diagnostic discrepancies were higher during the pandemic compared to last year; 16(35.5%) vs 5(6.8%), p=0.001. While this did not result in a significant impact on outcomes, in some cases, fear-induced cognitive bias may have altered decision-making and diagnostic processes. The sample size did not allow clear correlations; however, the study focused on assessing data on a case-by-case basis.

Conclusion: This study showed a high rate of diagnostic and management discrepancies in non-COVID-19 patients during the COVID-19 pandemic.