• Michael G Argenziano, Samuel L Bruce, Cody L Slater, Jonathan R Tiao, Matthew R Baldwin, R Graham Barr, Bernard P Chang, Katherine H Chau, Justin J Choi, Nicholas Gavin, Parag Goyal, Angela M Mills, Ashmi A Patel, Romney Marie-Laure S MS Department of Emergency Medicine, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA., Monika M Safford, Neil W Schluger, Soumitra Sengupta, Magdalena E Sobieszczyk, Jason E Zucker, Paul A Asadourian, Fletcher M Bell, Rebekah Boyd, Matthew F Cohen, MacAlistair I Colquhoun, Lucy A Colville, Joseph H de Jonge, Lyle B Dershowitz, Shirin A Dey, Katherine A Eiseman, Zachary P Girvin, Daniella T Goni, Amro A Harb, Nicholas Herzik, Sarah Householder, Lara E Karaaslan, Heather Lee, Evan Lieberman, Andrew Ling, Ree Lu, Arthur Y Shou, Alexander C Sisti, Zachary E Snow, Colin P Sperring, Yuqing Xiong, Henry W Zhou, Karthik Natarajan, George Hripcsak, and Ruijun Chen.
• Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
• BMJ. 2020 May 29; 369: m1996.

ObjectiveTo characterize patients with coronavirus disease 2019 (covid-19) in a large New York City medical center and describe their clinical course across the emergency department, hospital wards, and intensive care units.DesignRetrospective manual medical record review.SettingNewYork-Presbyterian/Columbia University Irving Medical Center, a quaternary care academic medical center in New York City.ParticipantsThe first 1000 consecutive patients with a positive result on the reverse transcriptase polymerase chain reaction assay for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who presented to the emergency department or were admitted to hospital between 1 March and 5 April 2020. Patient data were manually abstracted from electronic medical records.Main Outcome MeasuresCharacterization of patients, including demographics, presenting symptoms, comorbidities on presentation, hospital course, time to intubation, complications, mortality, and disposition.ResultsOf the first 1000 patients, 150 presented to the emergency department, 614 were admitted to hospital (not intensive care units), and 236 were admitted or transferred to intensive care units. The most common presenting symptoms were cough (732/1000), fever (728/1000), and dyspnea (631/1000). Patients in hospital, particularly those treated in intensive care units, often had baseline comorbidities including hypertension, diabetes, and obesity. Patients admitted to intensive care units were older, predominantly male (158/236, 66.9%), and had long lengths of stay (median 23 days, interquartile range 12-32 days); 78.0% (184/236) developed acute kidney injury and 35.2% (83/236) needed dialysis. Only 4.4% (6/136) of patients who required mechanical ventilation were first intubated more than 14 days after symptom onset. Time to intubation from symptom onset had a bimodal distribution, with modes at three to four days, and at nine days. As of 30 April, 90 patients remained in hospital and 211 had died in hospital.ConclusionsPatients admitted to hospital with covid-19 at this medical center faced major morbidity and mortality, with high rates of acute kidney injury and inpatient dialysis, prolonged intubations, and a bimodal distribution of time to intubation from symptom onset.© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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