The “after lockdown” period of 6 months was chosen in order to provide sufficient follow-up time for our primary outcomes. The “before lockdown” period of 2 months prior was chosen to establish a baseline of non–COVID-19 ICU admissions, considering our first confirmed case of COVID-19 in Colorado occurred on March 5, 2020. The primary covariate of interest (time of admission into the ICU) was divided into four periods: 1) pre lockdown: January 1, to Ma2) during lockdown: March 26, to Ap3) post lockdown (nonsurge): from April 27, to Octoand 4) surge period without a lockdown order: November 1, 2020, to March 31, 2021. Our primary research question aimed to define how mortality changed for patients with non–COVID-19 diagnoses in the ICU during COVID-19–related lockdown and subsequent pandemic surge periods. All study procedures were followed in accordance with the ethical standards of the responsible institutional committee on human experimentation and in accordance with the Helsinki Declaration of 1975. This study was deemed human subjects exempt given use of deidentified data (Category 4) the Colorado Institutional Review Board (IRB no. It is the largest health system in Colorado and parts of Southern Wyoming and Nebraska that provides advanced care to the region. The University of Colorado Health System is a nonprofit, academic institution with over 10 hospitals throughout Colorado. The dataset for this analysis was obtained from the University of Colorado Health Data Compass data repository comprising a retrospective cohort of ICU patients discharged between January 1, 2020, and March 31, 2021, across any of the UCH-affiliated hospitals. We used the natural experiment of the state-imposed lockdown to compare non-COVID-19–related mortality and admission diagnoses in ICU patients across the University of Colorado Hospital (UCH) system and to investigate whether mortality predictors differed before and after lockdown. To investigate these hypotheses, we analyzed our multihospital electronic medical record data for temporal trends in ICU admissions in the prepandemic period, during the state mandated lockdown period, and in the second nonmandated lockdown surge period. Our primary research questions were 1) did the lockdown alter the types (i.e., diagnosis flags) and frequencies of patients admitted to the medical ICU compared with nonlockdown periods before and after and 2) did patients with similar diagnoses experience worse outcomes during the lockdown compared with the nonlockdown periods. We posited that the reduction of healthcare access and delay in seeking care resulted in increased illness severity for non–COVID-19 conditions that may have increased non-COVID-19–related ICU mortality in the peripandemic period. Further, it is possible that the excess strain placed on the healthcare system reduced resources available for non-COVID-19–related issues resulting in delayed recognition or care. However, “normal” behaviors during this tumultuous time were changed by a variety of factors for example, hospital presentation hesitancy due to the perceived risk of contracting COVID-19 or less overall travelling behaviors and/or transportation access may reduce trauma emergencies. It is possible that ICU admission diagnoses would not be affected during the lockdown given that patients with severe non–COVID-19 disorders would still necessitate hospital presentation and admission. Coupled with this reduced hospital access, patients reported increased fear of COVID-19 exposure resulting in avoidance of healthcare systems contributing to delays in seeking care ( 21– 24). An unintended consequence of these mitigation measures was an overall reduction in the utilization of medical care for non-COVID-19–related diseases, including acute coronary syndrome ( 6– 9), heart failure hospitalizations ( 10), stroke admissions ( 11– 13), non–COVID-19 emergency department visits ( 14– 16), activation of trauma surgery ( 17), routine care for chronic medical conditions such as pulmonary hypertension ( 18) and liver disease ( 19), and psychiatric admissions ( 20). Along with adoption of social distancing measures ( 1, 2), healthcare systems worldwide appropriated new surge strategies to combat the tremendous increase in COVID-19 cases in order to allocate limited resources to acutely ill patients ( 3– 5). Response to the COVID-19 pandemic resulted in dramatic alterations in usual care with reduced access to outpatient services and routine procedures. Future studies should aim to understand mechanisms for temporal variation in ICU diagnoses and care delivery. Meanings: ICU admission diagnoses vary temporally with COVID-19 surge/lockdown periods for patients with non-COVID-19–related ICU issues.
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