IMPORTANCEThe National COVID Cohort Collaborative (N3C) is a centralized, harmonized, highgranularity electronic health record repository that is the largest, most representative COVID-19 cohort to date. This multicenter data set can support robust evidence-based development of predictive and diagnostic tools and inform clinical care and policy.OBJECTIVES To evaluate COVID-19 severity and risk factors over time and assess the use of machine learning to predict clinical severity. DESIGN, SETTING, AND PARTICIPANTSIn a retrospective cohort study of 1 926 526 US adults with SARS-CoV-2 infection (polymerase chain reaction >99% or antigen <1%) and adult patients without SARS-CoV-2 infection who served as controls from 34 medical centers nationwide between January 1, 2020, and December 7, 2020, patients were stratified using a World Health Organization COVID-19 severity scale and demographic characteristics. Differences between groups over time were evaluated using multivariable logistic regression. Random forest and XGBoost models were used to predict severe clinical course (death, discharge to hospice, invasive ventilatory support, or extracorporeal membrane oxygenation). MAIN OUTCOMES AND MEASURESPatient demographic characteristics and COVID-19 severity using the World Health Organization COVID-19 severity scale and differences between groups over time using multivariable logistic regression. RESULTSThe cohort included 174 568 adults who tested positive for SARS-CoV-2 (mean [SD] age, 44.4 [18.6] years; 53.2% female) and 1 133 848 adult controls who tested negative for SARS-CoV-2 (mean [SD] age, 49.5 [19.2] years; 57.1% female). Of the 174 568 adults with SARS-CoV-2, 32 472(18.6%) were hospitalized, and 6565 (20.2%) of those had a severe clinical course (invasive ventilatory support, extracorporeal membrane oxygenation, death, or discharge to hospice). Of the hospitalized patients, mortality was 11.6% overall and decreased from 16.4% in March to April 2020 to 8.6% in September to October 2020 (P = .002 for monthly trend). Using 64 inputs available on the first hospital day, this study predicted a severe clinical course using random forest and XGBoost models (area under the receiver operating curve = 0.87 for both) that were stable over time. The factor most strongly associated with clinical severity was pH; this result was consistent across machine learning methods. In a separate multivariable logistic regression model built for inference, (continued) Key Points Question In a US data resource large enough to adjust for multiple confounders, what risk factors are associated with COVID-19 severity and severity trajectory over time, and can machine learning models predict clinical severity? Findings In this cohort study of 174 568 adults with SARS-CoV-2, 32 472 (18.6%) were hospitalized and 6565 (20.2%) were severely ill, and first-day machine learning models accurately predicted clinical severity. Mortality was 11.6%
Objective To review the impact of COVID‐19 social restrictions on trauma presentations in South Australia. Methods Retrospective database review. Results During the period of social restrictions, there was a reduction in presentations of trauma and major trauma by 17% and 33%, respectively. The reduction in presentation rates was due to a large decrease in those aged over 40, with an increase in presentations in those younger than 40. Review by mechanism and location of injury revealed a reduction in road trauma, yet an increase in pedestrian trauma and trauma at home. Conclusion Social restrictions alter the characteristics of trauma presentations.
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