Access to intensive care in 14 European countries: a spatial analysis of intensive care need and capacity in the light of COVID-19
Access to intensive care in 14 European countries: a spatial analysis of intensive care need and capacity in the light of COVID-19
复制标题
14 个欧洲国家获得重症监护的情况：根据 COVID-19 对重症监护需求和能力的空间分析
DOI：
10.1007/s00134-020-06229-6
复制
发表时间：
2020-09-04
影响因子：
38.9
通讯作者：
Groneberg, David A.
中科院分区：
文献类型：
--
作者：
Bauer, Jan;Brueggmann, Doerthe;Groneberg, David A.
目的 2019 年冠状病毒病 (COVID-19) 给全球医疗保健系统带来了重大挑战。此次大流行证明了及时获得重症监护的重要性，因此，本研究旨在探讨 14 个欧洲国家重症监护病床的可及性及其对 COVID-19 病死率 (CFR) 的影响。方法 我们通过得出（1）重症监护床位与 10 万人口人均的区域比率（可达性指数，AI）和（2）到最近的重症监护病房的距离来检查重症监护病床的使用情况。横断面分析以 5 × 5 公里的空间分辨率进行，并对 14 个欧洲国家的全国结果进行了总结。在区域层面分析了 AI 和 CFR 之间的关系。结果 我们发现重症监护床位的使用水平存在国家层面的差异。德国的 AI 最高（AI = 35.3），其次是爱沙尼亚（AI = 33.5）和奥地利（AI = 26.4），瑞典（AI = 5）和丹麦（AI = 6.4）最低。到最近医院的平均旅行距离最高的是克罗地亚（25.3 分钟车程），最低的是卢森堡（9.1 分钟车程）。国家以下各级的结果表明，能力与人口密度和国家级清单有关。相关性分析显示 ICU 可及性与 COVID-19 CFR 呈负相关（r = - 0.57；p < 0.001）。结论 欧洲国家重症监护病床的地理分布存在显着差异，ICU 的可及性较低与较高的 COVID-19 死亡病例 (CFR) 比例相关。获取方面的重要差异是由于国家资源库存的规模以及医疗保健设施相对于人口的分布而造成的。我们的研究结果为官员们规划当前 COVID-19 大流行之外的公共卫生应对措施提供了资源，例如确定适合临时设施的潜在地点或制定后勤计划以将重症患者转移到有可用床位的设施。
Purpose The coronavirus disease 2019 (COVID-19) poses major challenges to health-care systems worldwide. This pandemic demonstrates the importance of timely access to intensive care and, therefore, this study aims to explore the accessibility of intensive care beds in 14 European countries and its impact on the COVID-19 case fatality ratio (CFR). Methods We examined access to intensive care beds by deriving (1) a regional ratio of intensive care beds to 100,000 population capita (accessibility index, AI) and (2) the distance to the closest intensive care unit. The cross-sectional analysis was performed at a 5-by-5 km spatial resolution and results were summarized nationally for 14 European countries. The relationship between AI and CFR was analyzed at the regional level. Results We found national-level differences in the levels of access to intensive care beds. The AI was highest in Germany (AI = 35.3), followed by Estonia (AI = 33.5) and Austria (AI = 26.4), and lowest in Sweden (AI = 5) and Denmark (AI = 6.4). The average travel distance to the closest hospital was highest in Croatia (25.3 min by car) and lowest in Luxembourg (9.1 min). Subnational results illustrate that capacity was associated with population density and national-level inventories. The correlation analysis revealed a negative correlation of ICU accessibility and COVID-19 CFR (r = - 0.57;p < 0.001). Conclusion Geographical access to intensive care beds varies significantly across European countries and low ICU accessibility was associated with a higher proportion of COVID-19 deaths to cases (CFR). Important differences in access are due to the sizes of national resource inventories and the distribution of health-care facilities relative to the human population. Our findings provide a resource for officials planning public health responses beyond the current COVID-19 pandemic, such as identifying potential locations suitable for temporary facilities or establishing logistical plans for moving severely ill patients to facilities with available beds.