Differential trends of admissions in accident and emergency departments during the COVID-19 pandemic in Germany

Abstract

Background Recent studies have shown a decrease of admissions to accident and emergency (A&E) departments after the local outbreaks of COVID-19. However, differential trends of admission counts, for example according to diagnosis, are less well understood. This information is crucial to inform targeted intervention. Therefore, we aimed to compare admission counts in German A&E departments before and after 12th march in 2020 with 2019 according to demographic factors and diagnosis groups. Methods Routine data of all admissions between 02.12.2019–30.06.2020 and 01.12.2018–30.06.2019 was available from six hospitals in five cities from north-western, eastern, south-eastern, and south-western Germany. We defined 10 diagnosis groups using ICD-10 codes: mental disorders due to use of alcohol (MDA), acute myocardial infarction (AMI), stroke or transient ischemic attack (TIA), heart failure, pneumonia, chronic obstructive pulmonary disease (COPD), cholelithiasis or cholecystitis, back pain, fractures of the forearm, and fractures of the femur. We calculated rate ratios comparing different periods in 12.03.2020–30.06.2020 with 12.03.2019–30.06.2019. Results Forty-one thousand three hundred fifty-three cases were admitted between 12.03.2020–30.06.2020 and 51,030 cases between 12.03.2019–30.06.2019. Admission counts prior to 12.03. were equal in 2020 and 2019. In the period after 12.03., the decrease of admissions in 2020 compared to 2019 was largest between 26.03. and 08.04. (− 30%, 95% CI − 33% to − 27%). When analysing the entire period 12.03.-30.06., the decrease of admissions was heterogeneous among hospitals, and larger among people aged 0–17 years compared to older age groups. In the first 8 weeks after 12.03., admission counts of all diagnoses except femur fractures and pneumonia declined. Admissions with pneumonia increased in this early period. Between 07.05. and 30.6.2020, we noted that admissions with AMI (+ 13%, 95% CI − 3% to + 32%) and cholelithiasis or cholecystitis (+ 20%, 95% CI + 1% to + 44%) were higher than in 2019. Conclusions Our results suggest differential trends of admission counts according to age, location, and diagnosis. An initial decrease of admissions with MDA, AMI, stroke or TIA, heart failure, COPD, cholelithiasis or cholecystitis, and back pain imply delays of emergency care in Germany. Finally, our study suggests a delayed increase of admissions with AMI and cholelithiasis or cholecystitis.

Effects of Relaxed Lockdown on Pediatric ER Visits during SARS-CoV-2 Pandemic in Italy

“…Along this hypothesis, several studies demonstrated a drastic drop in pediatric ER visits for accidents during the lockdown period [ 6 , 38 , 39 ]. This decreasing trend is confirmed also by more recent published works that analyzed different timeframes, in particular until June [ 40 ] and August [ 41 ] 2020, when strict lockdown measures were patchily reintroduced. In the present work, analyzing ER visits in September–November 2020, we confirm this decreasing trend in accidents even when lockdown measures were relaxed, allowing several social activities reopening, such as schools.…”

Changes in nationwide in-hospital stroke care during the first four waves of COVID-19 in Germany

“…13 Like other authors, we observed the opposite, namely a decrease in hospitalization rate for AIS during the initial wave, and normal AIS hospitalization rates at later stages of the pandemic. [1][2][3][4][5][6][7][8][9] Certain selective processes during the pandemic are also implied by the fact that comorbidities among AIS patients were consistently less frequent throughout the pandemic and by a decrease in the CMI during all four pandemic waves.…”

“…During the early stages of the global COVID-19 pandemic, the prevalence of hospitalization for acute ischemic stroke (AIS) decreased and, in some countries, AIS case fatality rose. [1][2][3][4][5][6][7][8][9] These findings are unusual given that the overwhelming majority of cases were SARS-CoV-2-negative patients and hospitals in most parts of the world were accessible for emergency stroke care without significant interruption of service. 1,[10][11][12] The most commonly suggested explanation is that fear of hospital-acquired COVID-19 caused AIS patients to delay or defer hospital presentation.…”

The impact of COVID-19 on paediatric emergency department visits. A one-year retrospective study

“…It is well known that there is an overuse of the Health Systems in many countries, which creates a drain of resources. 15 Inappropriate resource utilization compromises the systems’ ability to deliver quality primary care services to all patients and this may worsen the health outcomes of children suffering from acute conditions (e.g. due to increased waiting times, exhaustion of clinicians), not to mention the increase in the health-care cost.…”