Variability in COVID-19 in-hospital mortality rates between national health service trusts and regions in England: A national observational study for the Getting It Right First Time Programme.

BACKGROUND: A key first step in optimising COVID-19 patient outcomes during future case-surges is to learn from the experience within individual hospitals during the early stages of the pandemic. The aim of this study was to investigate the extent of variation in COVID-19 outcomes between National Health Service (NHS) hospital trusts and regions in England using data from March-July 2020. METHODS: This was a retrospective observational study using the Hospital Episode Statistics administrative dataset. Patients aged ≥ 18 years who had a diagnosis of COVID-19 during a hospital stay in England that was completed between March 1st and July 31st, 2020 were included. In-hospital mortality was the primary outcome of interest. In secondary analysis, critical care admission, length of stay and mortality within 30 days of discharge were also investigated. Multilevel logistic regression was used to adjust for covariates. FINDINGS: There were 86,356 patients with a confirmed diagnosis of COVID-19 included in the study, of whom 22,944 (26.6%) died in hospital with COVID-19 as the primary cause of death. After adjusting for covariates, the extent of the variation in-hospital mortality rates between hospital trusts and regions was relatively modest. Trusts with the largest baseline number of beds and a greater proportion of patients admitted to critical care had the lowest in-hospital mortality rates. INTERPRETATION: There is little evidence of clustering of deaths within hospital trusts. There may be opportunities to learn from the experience of individual trusts to help prepare hospitals for future case-surges.

Gender differences in cardiovascular tolerance to short radius centrifugation.

In preparing for the NASA Artificial Gravity Pilot Study the planned centrifuge loading protocol was tested in 11 ambulatory subjects (6 men, 5 women). Each was subjected to a single 60 min trial with 2.5G of equivalent gravitational load feet and 1G at the level of the mediastinum. Amongst the men, 5/6 completed the trial successfully with no adverse sequelae. However, amongst the women, 4/5 tests were stopped early because of presyncope. Women are known to have a greater predisposition to syncope following orthostatic stress under normal tilt table conditions, during lower body negative pressure and following space flight. Amongst the factors which may have contributed to their lower tolerance to centrifugation are anthropometric factors, the vasoactive effects of sex hormones, catecholamine levels, ability to augment total peripheral resistance in response to orthostatic stress, and structural differences in cardiac anatomy and physiology. However, determining the true cause of this difference will require further investigation.