Annals for Hospitalists - March 2021
Authors: David H. Wesorick, Jawad Al-Khafaji, Matthew Luzum
Journal: Annals of Internal Medicine (2021)

Web ExclusivesMarch 2021Annals for Hospitalists - March 2021FREEDavid H. Wesorick, MD*, Jawad Al-Khafaji, MD, MSHA*, Matthew Luzum, MD*David H. Wesorick, MD*From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (D.H.W, J.A., M.L.)Search for more papers by this author, Jawad Al-Khafaji, MD, MSHA*From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (D.H.W, J.A., M.L.)Search for more papers by this author, Matthew Luzum, MD*From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (D.H.W, J.A., M.L.)Search for more papers by this authorAuthor, Article and Disclosure Informationhttps://doi.org/10.7326/AWHO202103160 SectionsAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Inpatient NotesTimely Hip Fracture Surgery—Flavia K. Borges, MD, PhD, and P.J. Devereaux, MD, PhDA hip fracture results in prothrombotic, catabolic, and stress states associated with pain, bleeding, inflammation, and immobilization. The authors of this commentary suggest that urgent surgery should be the priority for these patients and question the conventional wisdom of prolonged surgical delays to allow for medical optimization.Highlights of Recent Articles From Annals of Internal MedicineRacial and Ethnic Disparities in COVID-19–Related Infections, Hospitalizations, and Deaths: A Systematic ReviewAnn Intern Med. 2021;174:362–373. Published 1 December 2020. doi:10.7326/M20-6306This article reviewed 37 mostly fair-quality cohort and cross-sectional studies, 15 mostly good-quality ecological studies, and data from the Centers for Disease Control and Prevention and the APM Research Lab. These data show that African American/Black and Hispanic populations experience disproportionately higher rates of severe acute respiratory syndrome coronavirus 2 infection, hospitalization, and coronavirus disease 2019 (COVID-19)–related mortality, but not higher case-fatality rates (that is, in-hospital mortality), than non-Hispanic White populations. Lower-strength evidence suggests that Asian populations experience outcomes that are similar to those of non-Hispanic White populations.Key points for hospitalists include:Moderate- to high-strength evidence confirms that African American/Black and Hispanic populations are more likely to contract, be hospitalized with, and die of COVID-19 than White and Asian populations.The authors call for further research to better understand the drivers of these disparities and for urgent interventions to mitigate them.Surviving COVID-19 After Hospital Discharge: Symptom, Functional, and Adverse Outcomes of Home Health RecipientsAnn Intern Med. 2021;174:316–325. Published 24 November 2020. doi:10.7326/M20-5206This retrospective cohort study examined the post-hospital courses of 1409 patients with COVID-19 in New York City who were discharged from the hospital with home health care (HHC) services. The HHC was continued, on average, for 32 days. About 10% of patients were rehospitalized, and less than 1% died. Heart failure and complicated diabetes were among the significant risk factors for readmission or death. Overall, patients demonstrated a significant decrease in the number of activity-of-daily-living/instrumental activity-of-daily-living dependencies over the course of their recovery, with more than 80% of patients having 4 or more dependencies at the time of HHC admission, and more than 60% of patients having no dependencies at the time of discharge. Similarly, whereas only 16% of patients were free of dyspnea at the time of admission to HHC, 73% were without dyspnea by the time of discharge.Key points for hospitalists include:This study shows that patients often have significant dyspnea and severe functional dependency after COVID-19 hospitalizations. However, most patients in this study had substantial improvements in symptoms and function after hospital discharge.Relatively few of these patients were rehospitalized or died during their HHC course. Not surprisingly, several comorbidities and disabilities were risk factors for readmission or death.The Latest From Journal ClubWhich interventions are recommended for preventing COVID-19 in health care settings?IDSA made 4 strong recommendations for preventing COVID-19 infection in health care personnelAnn Intern Med. 2021;174:JC14. doi:10.7326/ACPJ202102160-014After reviewing multiple sources of evidence, an expert panel made recommendations for preventing COVID-19 infection in health care workers. Their recommendations include the use of surgical masks or respirators (N95, N99, or powered air-purifying respirator) in routine care of patients with COVID-19 and the use of respirators in aerosol-generating procedures. In contingency situations or crisis capacity, they endorsed the reprocessing of respirators and the addition of a face shield or surgical mask to cover the respirator to extend its use or allow for reuse.Do remdesivir, hydroxychloroquine, lopinavir, or interferon β-1a improve mortality in hospitalized patients with COVID-19?In inpatients with COVID-19, none of remdesivir, hydroxychloroquine, lopinavir, or interferon β-1a differed from standard care for in-hospital mortalityAnn Intern Med. 2021;174:JC17. doi:10.7326/ACPJ202102160-017This article provides interim results of the multinational World Health Organization Solidarity trial. This blinded randomized controlled trial found no in-hospital mortality benefit for any of these medications.Can early respiratory decompensation be predicted in patients hospitalized with COVID-19?In adults hospitalized with COVID-19, the quick COVID-19 Severity Index predicted 24-h respiratory decompensationAnn Intern Med. 2021;174:JC23. doi:10.7326/ACPJ202102160-023This retrospective cohort study derived and cross-validated (n = 932) and independently validated (n = 240) a model to predict early decompensation (within 24 hours of admission) of patients with COVID-19. The score uses 3 variables (respiratory rate, lowest pulse oximetry reading, and oxygen flow rate) to predict the risk for decompensation and has a sensitivity and specificity of 79% and 78%, respectively.Does tocilizumab improve outcomes in hospitalized patients with COVID-19?Tocilizumab did not reduce hypoxic respiratory failure or death in hospitalized patients with COVID-19Ann Intern Med. 2021;174:JC16. doi:10.7326/ACPJ202102160-016This multicenter, blinded trial randomly assigned moderately ill patients with COVID-19 to a single dose of intravenous tocilizumab or placebo. Tocilizumab was not associated with lower rates of mechanical ventilation or death but was associated with higher rates of neutropenia and infection.Sign up here to have Annals for Hospitalists delivered to your inbox each month. Comments0 CommentsSign In to Submit A Comment Author, Article and Disclosure Information* The authors are co-first authors and contributed equally to the article. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals for Hospitalists Inpatient Notes - Timely Hip Fracture Surgery Flavia K. Borges and P.J. Devereaux Metrics March 2021Volume 174, Issue 3Page: HO3KeywordsHospitalizationsCOVID-19SurgeryPopulation statisticsRespiratorsMedical risk factorsDyspneaCohort studiesHospitalists ePublished: 16 March 2021 Issue Published: March 2021 CopyrightCopyright © 2021 by American College of Physicians. All Rights Reserved.Loading ...