Intended for healthcare professionals

  1. George L Anesi, instructor of medicine1,
  2. Scott D Halpern, professor of medicine2,
  3. M Kit Delgado, assistant professor of emergency medicine3
  1. 1Palliative and Advanced Illness Research (PAIR) Center, Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
  2. 2Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
  3. 3Center for Emergency Care Policy and Research, Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
  1. Correspondence to: M Kit Delgado kit.delgado{at}uphs.upenn.edu

Lessons from rigorous inpatient studies will inform long term follow-up and continuing care

Cohort studies and case series of patients with coronavirus disease 2019 (covid-19) have spread almost as quickly as the virus,12345 with inadequate methodological quality sometimes hampering thoughtful interpretation. For example, one New York cohort study initially reported a mortality of 88% for patients requiring mechanical ventilation before readers’ responses led to a correction clarifying that the rate was 25% and would grow to an uncertain extent because 72% of patients were still in hospital.4 In contrast, the two linked cohort studies from the United States provide rigorous outcome ascertainment and adjustment for case mix.67 By delaying publication until most enrolled patients had confirmed outcomes and by using modern survival analysis methods these authors have greatly enhanced our understanding of the epidemiology of covid-19.

Lewnard and colleagues (doi:10.1136/bmj.m1923) report on 1840 people with covid-19 at Kaiser Permanente system hospitals in California and Washington state.6 Median age was 61 years with 25% being 48 years or younger. The authors used survival analysis methods adjusted for patient characteristics to account for those who remained in hospital at the time of analysis. The study reported incidence of hospital …

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