TY - JOUR T1 - Evolution in disease severity during the E-cigarette or Vaping-Associated Lung Injury (EVALI) outbreak JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.congress-2020.4388 VL - 56 IS - suppl 64 SP - 4388 AU - Michael Lanspa AU - Dixie Harris AU - Braden Anderson AU - Sean Callahan AU - Susan Rea AU - Dave Collingridge AU - David Guidry AU - Colin Grissom AU - Denitza Blagev Y1 - 2020/09/07 UR - http://erj.ersjournals.com/content/56/suppl_64/4388.abstract N2 - Introduction: In 2019, the USA experienced an outbreak of E-cigarette or Vaping-Associated Lung Injury (EVALI). Clinicians, government, and media publicized the EVALI outbreak. We hypothesized that such publicity might yield a trend of earlier presentation with less severe disease as the outbreak continued.Methods: We studied all patients who presented with EVALI at an Intermountain hospital or clinic between the first case (Jun 27, 2019) and Jan 9, 2020. We compared patients who presented early in the outbreak (prior to date of median case) to those who presented later. Our primary outcome was hospital length-of-stay (LOS), with secondary outcomes of ICU admission and respiratory failure (receipt of mechanical ventilation, non-invasive positive pressure ventilation, or high-flow nasal cannula). We used Wilcoxon rank-sum for comparison of central tendencies and Fisher’s exact test for proportions. We modeled association between date and hospital LOS and respiratory failure using regression.Results: We identified 114 patients from 13 centers. Median age was 28, 67% were male. Patients presenting later in the outbreak had shorter LOS compared to those who presented early (median 3 days, IQR 1-5 vs. 5, IQR 2-8, p <0.01), and had less respiratory failure (31% vs. 53%, p=0.02). We observed no difference in ICU admission (31% vs 38%, p=0.43). Week of presentation was associated with shorter LOS (coefficient -0.18, 95%CI -0.34, -0.02, p=0.02) and with decreased respiratory failure (OR 0.93, 95%CI 0.87, 0.99, p=0.03).Conclusions: Hospital LOS and respiratory failure decreased during the EVALI outbreak, suggesting milder presentation as the outbreak progressed.FootnotesCite this article as: European Respiratory Journal 2020; 56: Suppl. 64, 4388.This abstract was presented at the 2020 ERS International Congress, in session “Respiratory viruses in the "pre COVID-19" era”.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only). ER -