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Higher clinical acuity and 7-day hospital mortality in non-COVID-19 acute medical admissions: prospective observational study
  1. Marcus J Lyall1,
  2. Nazir I Lone2
  1. 1Edinburgh Centre for Endocrinology and Diabetes, NHS Lothian, Edinburgh, UK
  2. 2Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Marcus J Lyall, Edinburgh Centre for Endocrinology and Diabetes, NHS Lothian, Edinburgh EH1 3EG, UK; marcus.lyall{at}


Objectives To understand the effect of COVID-19 lockdown measures on severity of illness and mortality in non-COVID-19 acute medical admissions.

Design A prospective observational study.

Setting 3 large acute medical receiving units in NHS Lothian, Scotland.

Participants Non-COVID-19 acute admissions (n=1682) were examined over the first 31 days after the implementation of the COVID-19 lockdown policy in the UK on 23 March 2019. Patients admitted over a matched interval in the previous 5 years were used as a comparator cohort (n=14 954).

Main outcome measures Patient demography, biochemical markers of clinical acuity and 7-day hospital inpatient mortality.

Results Non-COVID-19 acute medical admissions reduced by 44.9% across all three sites in comparison with the mean of the preceding 5 years (p<0.001). Patients arriving during this period were more likely to be male, of younger age and to arrive by emergency ambulance transport. Non-COVID-19 admissions during lockdown had a greater incidence of acute kidney injury, lactic acidaemia and an increased risk of hospital death within 7 days (4.2% vs 2.5%), which persisted after adjustment for confounders (OR 1.87, 95% CI 1.43 to 2.41, p<0.001).

Conclusions These data demonstrate a significant reduction in non-COVID-19 acute medical admissions during the early weeks of lockdown. Patients admitted during this period were of higher clinical acuity with a higher incidence of early inpatient mortality.

  • acute care
  • death/mortality

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  • Handling editor Jason E Smith

  • Twitter @marcus_lyall

  • Contributors MJL (guarantor): design of study, data collection and linkage, statistical analysis and manuscript preparation. NIL: study design, statistical analysis and manuscript preparation.

  • Funding MJL is supported by an NHS research Scotland Clinical Fellowship. NIL declares no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. This project was conducted without influence from the respective funding bodies.

  • Competing interests None declared.

  • Patient and public involvement statement We did not directly include PPI in this study, but the database used in the study was developed with PPI and is updated by a committee that includes patient representatives.

  • Patient consent for publication Not required.

  • Ethics approval The study was reviewed by the Quality Improvement Team and registered in NHS Lothian as a Quality Improvement project. Following the NHS Health Research Authority decision tool and after seeking advice from NHS Lothian Research and Development department, the study was deemed to be service evaluation and therefore formal ethical approval was not required. All data were anonymised before analysis and complied with local data protection requirements.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. Data are obtained from Lothian Analytics Services at NHS Lothian. Subject to appropriate local governance procedures, requests can be made for access. Please contact corresponding author.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.