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IntroductionCôte d’Ivoire is facing a second wave of the novel coronavirus disease 2019 (COVID-19). While social distancing measures (SDM) may be an option to address this wave, SDM may be devastating, especially if they have a minimal impact on the spread of COVID-19, given the other measures in place.MethodsWe conducted a cohort study involving cases that had occurred as at June 30, 2020. We used data from the Government’s situation reports. We established three study periods, which correspond to the implementation and easing of SDM, including a 10-day delay for test results: (1) the SDM (March 11 - May 24), (2) the no SDM (May 25 - June 21), and (3) the pseudo SDM (June 22 - July 10) periods. We compared the incidence rate during these periods using Poisson regression, with sex, age, and the average daily number of tests as covariates.ResultsAs at July 10, there were 12,052 cases. The incidence rate was 100% higher during period 2 compared to period 1 (incidence rate ratio = 2.05, 95% confidence interval: 1.75-2.41) and 25% lower during period 3 compared to period 2 (0.75 [0.66-0.86]).ConclusionsThe easing and subsequent reinforcement of SDM had a significant impact on the spread of COVID-19 in Côte d’Ivoire. The other mitigation measures either did not compensate for the easing of the SDM during the no SDM period or were not fully effective throughout the study periods; they should be strengthened before the SDM are reimplemented.

Objective: Evaluate interhospital variation in resource use for in-hospital injury deaths. Background: Significant variation in resource use for end-of-life care has been observed in the US for chronic diseases. However, there is an important knowledge gap on end-of-life resource use for trauma patients. Methods: We conducted a multicenter, retrospective cohort study of injury deaths following hospitalization in any of the 57 trauma centers in a Canadian trauma system (2013)(2014)(2015)(2016). Resource use intensity was measured using activity-based costing (2016 $CAN) according to time of death (72 h, 3-14 d, !14 d). We used multilevel log-linear regression to model resource use and estimated interhospital variation using intraclass correlation coefficients (ICC). Results: Our study population comprised 2044 injury deaths. Variation in resource use between hospitals was observed for all 3 time frames (ICC ¼ 6.5%, 6.6%, and 5.9% for < 72 h, 3-14 d, and !14 d, respectively). Interhospital variation was stronger for allied health services (ICC ¼ 18 to 26%), medical imaging (ICC ¼ 4 to 10%), and the ICU (ICC ¼ 5 to 6%) than other activity centers. We observed stronger interhospital variation for patients < 65 years of age (ICC ¼ 11 to 34%) than those !65 (ICC ¼ 5 to 6%) and for traumatic brain injury (ICC ¼ 5 to 13%) than other injuries (ICC ¼ 1 to 8%). Conclusions: We observed variation in resource use intensity for injury deaths across trauma centers. Strongest variation was observed for younger patients and those with traumatic brain injury. Results may reflect variation in level of care decisions and the incidence of withdrawal of life-sustaining therapies.

Background:The knowledge gap regarding acute care resource use for patients with traumatic brain injury (TBI) impedes efforts to improve the efficiency and quality of the care of these patients. Our objective was to evaluate interhospital variation in resource use for patients with TBI, identify determinants of high resource use and assess the association between hospital resource use and clinical outcomes. Methods:We conducted a multicentre retrospective cohort study including patients aged 16 years and older admitted to the inclusive trauma system of Quebec following TBI, between 2013 and 2016. We estimated resource use using activity-based costs. Clinical outcomes included mortality, complications and unplanned hospital readmission. Interhospital variation was evaluated using intraclass correlation coefficients (ICCs) with 95% confidence intervals (CIs). Correlations between hospital resource use and clinical outcomes were evaluated using correlation coefficients on weighted, risk-adjusted estimates with 95% CIs. Results:We included 6319 patients. We observed significant interhospital variation in resource use for patients discharged alive, which was not explained by patient case mix (ICC 0.052, 95% CI 0.043 to 0.061). Adjusted mean resource use for patients discharged to long-term care was more than twice that of patients discharged home. Hospitals with higher resource use tended to have a lower incidence of mortality (r -0.347, 95% CI -0.559 to -0.087) and unplanned readmission (r -0.249, 95% CI -0.481 to 0.020) but a higher incidence of complications (r 0.491, 95% CI 0.255 to 0.666). Conclusion:Resource use for TBI varies significantly among hospitals and may be associated with differences in mortality and morbidity. Negative associations with mortality and positive associations with complications should be interpreted with caution but suggest there may be a trade-off between adverse events and survival that should be evaluated further. Contexte :Le manque de données sur l'utilisation des ressources en soins aigus chez les patients victimes d'un traumatisme crânien (TC) nuit aux efforts pour améliorer l'efficience et la qualité de leurs soins. Notre objectif était d'évaluer les variations quant à l'utilisation des ressources chez les patients victimes de traumatismes crâniens entre les hôpitaux, d'identifier les déterminants d'une grande utilisation des ressources et d'analyser le lien entre l'utilisation des ressources hospitalières et les résultats cliniques.Méthodes : Nous avons procédé à une étude de cohorte rétrospective multicentrique sur des patients âgés de 16 ans et plus admis dans le système intégré de traumatologie au Québec après un TC, entre 2013 et 2016. Nous avons estimé l'utilisation des ressources à partir des coûts basés sur les activités. Les résultats cliniques incluaient mortalité, complications et réhospitalisation non planifiée. La variation entre les hôpitaux a été évaluée à l'aide de coefficients de corrélation intraclasse (CCIC), avec des intervalles de confiance (IC) de 95 %. Les ...