عوامل موثر بر بستری شدن و طول مدت بستری در بیماران مبتلا به کووید19

زمینه و اهداف بخش قابل توجهی از بیماران کووید19 در بیمارستان بستری می شوند. تعداد کمی مطالعه عوامل مرتبط با بستری شدن این بیماران را بررسی کرده اند. این مطالعه با هدف بررسی عوامل موثر بر بستری شدن و طول مدت بستری در بیماران مبتلا به کووید19 در بیمارستان شهدا امام حسین تهران در نیمه اول سال 1399 انجام شد. مواد و روش ها این مطالعه مقطعی با روش نمونه گیری در دسترس انجام شد. اطلاعات با استفاده از یک چک لیست پژوهشگر ساخت دو قسمتی جمع آوری شد. چک لیست جهت بررسی روایی محتوا به 15 نفر متخصص در رشته های اپیدمیولوژی، پرستاری، آمار و پزشک عمومی ارسال شد. شاخص روایی محتوا (cvi) و نسبت روایی محتوا (cvr) جهت بررسی چک لیست و جهت بررسی رابطه متغیرهای مورد بررسی از آزمون های تی دو گروه مستقل، تی تست، تحلیل واریانس تک راهه، آزمون اسپیرمن و پیرسون در سطح معنی داری 0.05 استفاده شد. یافته ها آلفای کرونباخ چک لیست مطالعه برابر با (0.824 = r) بود. مقدار کل شاخص cvi برای کل چک لیست برابر با 0.870 بود و مقدار شاخص cvr کل چک لیست نیز برابر با 0.733 بود لذا چک لیست مطالعه، روایی و پایایی لازم را داشت. در این مطالعه 291 بیمار شرکت کردند. میانگین و انحراف معیار طول مدت بستری بیماران در بیمارستان برابر با 4.14 ± 7.59 روز بود. بین وجود سابقه اختلالات کلیوی (0.034=pvalue)، وجود علامت های تنگی نفس (0.007=pvalue) و تهوع (0.016 =pvalue)، اکسیژن درمانی (0.022=pvalue)، مصرف داروهای آپوتل (0.045=pvalue)، کالترا (0.020=pvalue) و هیدروکسی کلروکین (0.022=pvalue) توسط بیمار با طول کل مدت بستری در بیمارستان رابطه معنی دار وجود داشت. نتیجه گیری علامت تنگی نفس، سن و اکسیژن درمانی مهم ترین عوامل موثر بر طول مدت بستری بیماران در بیمارستان است. بنابراین پزشکان و پرستاران باید استفاده از اکسیژن درمانی برای بیماران به ویژه بیماران مسن مبتلا به تنگی نفس را در اولویت قرار دهند تا با تسریع بهبود بیماران موجب کاهش طول مدت بستری آن ها شوند.

Factors Affecting Hospitalization and Length of Hospitalization of the Patients with Covid19

Background and Objectives Although a significant number of Covid19 patients tend to be hospitalized, few studies have explored the factors related to the hospitalization of these patients. This study was conducted to investigate the factors affecting the hospitalization and duration of hospitalization of the patients with Covid19 in Shohada Imam Hossein Hospital in Tehran in the first half of 2020. Material and Methods This crosssectional study was performed by convenience sampling method. Data were collected using a twopart researchermade checklist. The checklist was sent to 15 specialists in the fields of epidemiology, nursing, statistics and general practitioners to check the content validity. Content validity index (CVI) and content validity ratio (CVR) were used to check the validity of the content of the checklist and Cronbach's alpha index was used to assess the reliability. To investigate the relationship between the studied variables, independent ttest, ttest, oneway analysis of variance, Spearman and Pearson test were used at a significance level of 0.05. Results The Cronbach's alpha index of the study checklist was equal to (r = 0.824). The total values of the CVI and CVR index for the whole checklist were found to be 0.870 and 0.733respectively.Therefore, it can be claimed that the checklist used in this study an acceptable level of content validity. 291 patients participated in this study. The mean and standard deviation of the length of hospital stay was 7.59 ± 4.14 days. There was a significant relationship between total length of hospital stay and each of the following variables: history of renal impairment (Pvalue = 0.034), presence of symptoms of shortness of breath (Pvalue = 0.007), nausea (Pvalue = 0.016), oxygen therapy (Pvalue = 0.022), use of Apotel (Pvalue = 0.045), use of Kaltera (Pvalue = 0.020), and hydroxychloroquine use (Pvalue = 0.022). Conclusion Symptoms of dyspnea, age, and oxygen therapy were the most important factors influencing the length of hospital stay. Thus, physicians and nurses should prioritize the use of oxygen therapy for patients, especially the elderly ones with the symptoms of dyspnea, in order to accelerate the recovery of the patients, and consequently reduce the duration of hospitalization. Extended Abstract Background and Objectives Covid19 is an emerging disease that has quickly become a global problem, spreading to every country and becoming a pandemic. A significant number of Covid19 patients are hospitalized. Few studies have studied the factors related to the hospitalization of these patients. This study was conducted to investigate the factors affecting the hospitalization and duration of hospitalization of the patients with Covid19 in Shohada Imam Hossein Hospital in Tehran in the first half of 2020. Material and Methods This crosssectional study was completed by convenience samplingmethod. Data were collected using a researchermade twopart checklist. Demographic information and underlying diseases part included gender with two female and male options, quantitative and crude age, one 13choice question and 5 twochoice yes or no questions. The other part, information on Covid19 disease status of the participants, consisted of a 3choice question, 5 yes or no questions, a 9choice question, and 6 openended questions. Content validity index (CVI) and content validity ratio (CVR) were used to check the validity of the content of the checklist and Cronbach's alpha index was used to assess the reliability. To investigate the relationship between the studied variables, independent ttest, ttest, oneway analysis of variance, Spearman and Pearson test were employed at a significance level of 0.05. Results The value of Cronbach's alpha calculating the reliability of the checklist was equal to (r = 0.824). The total value of the CVI index for the whole checklist was equal to 0.870 and the value of the total CVR index of the total checklist was calculated to be 0.733, so the content validity of the checklist was established. 291 patients participated in this study, 150 of whom (51.50%) were female. The mean and standard deviation of the participants’ age in this study was 58.81 ± 18.75., 51 (17.52%) patients had to stay in intensive care unit (ICU) all or part of their hospital stay. Oxygen therapy was performed for 162 patients (55.67%) and the mean and standard deviation of oxygen therapy was 4.73 ± 42 2.42 liters per minute. 9 patients (3.09%) were intubated during their hospitalization. The most common symptom of Covid19 disease was a cough in 144 patients (49.48%). The most commonly used drugs for the treatment of patients were hydroxychloroquine 225 (77.32%)), naproxen (199 (68.38%) and cefotaxime (106 (36.43%)). The mean and standard deviation of the length of hospital stay was 7.59 ± 4.14 days. There was a significant relationship between the history of renal impairment (Pvalue = 0.034), the presence of symptoms of shortness of breath (Pvalue = 0.007), nausea (Pvalue = 0.016), oxygen therapy (Pvalue = 0.022), use of Apotel (Pvalue = 0.045), use of Kaltera (Pvalue = 0.020), use of hydroxychloroquine (Pvalue = 0.022) and the total length of hospital stay. There was a very weak positive correlation (r = 0.061) between the length of hospital stay in the intensive care unit and the age of the patients, which was not significant (Pvalue = 0.718). There was a significant relationship between age and the final outcome of the disease in patients (Pvalue = 0.013). Conclusion Since hydroxychloroquine and azithromycin therapies are not usually important factors in the treatment of patients with Covid19, their effect was only marginal on the period of hospitalization and consequently these drugs cannot be considered as factors determining the duration of hospitalization. Symptoms of dyspnea, age, and oxygen therapy were the most important factors influencing the length of hospital stay. Thus, physicians and nurses should prioritize the use of oxygen therapy for patients, especially the elderly ones with the symptoms of dyspnea, in order to accelerate the recovery of the patients, and consequently reduce the duration of hospitalization. Practical Implications of Research According to the results of this study, we suggest that physicians and nurses use more oxygen therapy to treat patients to accelerate the recovery of these patients, reduce the length of hospital stay, and ultimately to reduce health care costs. Oxygen therapy is the most important practical measure in reducing the length of hospital stay of patients. Ethical Considerations The patients signed informed consent forms and the information was collected anonymously without being returned to the person. In addition, each patient could leave the study if they wanted to, or not answer the questions, without any consequences for them due to their withdrawal. Conflict of Interest We hereby declare that we have no conflict of interest in conducting this study with any organization, natural person or legal entity. Aknowledgment We would like to thank the nurses of Imam Hossein Shohada Hospital in Tehran, the patients who participated in this study and all those who helped us in doing this research study. This study is a continuation of a research project with ethics code number IR.IUMS.FMD.REC.1399.323 and supported by Iran University of Medical Sciences.