Cross-sectional analysis of avoidable emergency department visits before and during the COVID-19 pandemic

Gottlieb, Michael; Schipfer, Ryan; Shah, Shital; McKinney, Dennis; Casey, Paul; Stein, Brian; Thompson, Doug

doi:10.1016/j.ajem.2023.01.044

Cited by 3 publications

(1 citation statement)

References 16 publications

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“…This evidence presented in Table 2 is also crucial because the extension of processing times in EDs during the post-pandemic phase has already been shown in the literature, particularly in studies concerning all ED admissions [ 36 , 37 , 38 , 39 , 40 , 41 ]; however, our study is the first to demonstrate that this phenomenon also specifically impacted time-dependent pathologies, such as strokes. We believe that specific analyses are necessary to better understand the potential clinical impact of increased processing time in EDs in terms of disability or other outcomes.…”

Section: Discussionsupporting

confidence: 65%

Italy’s Post-COVID-19 Stroke Network: Has It Returned to Pre-Pandemic Standards?

Kacerik,

Bottega,

Andreassi

et al. 2024

Epidemiologia

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The COVID-19 pandemic strongly transformed the healthcare system in the Lombardy region (Italy), forcing a rapid reorganization of hospital structures. The emergency medical service (EMS) system and emergency departments (EDs) were among the most affected departments. Several studies have shown a change in the epidemiology of time-dependent pathologies, such as stroke, during the pandemic’s peak. However, there is little scientific evidence regarding the interpandemic phase. The regional register for ED accesses (EUOL) was analyzed, taking into consideration all accesses for stroke and stroke-like syndromes during the years 2019, 2020, and 2021. The analysis shows a significant difference in the average number of diagnoses per month [2092 vs. 1815 vs. 2015, respectively (p < 0.05)] and an increase in the percentage of transports carried out by EMS vehicles to EDs [17% vs. 25% vs. 22%, respectively (p < 0.05)]. The length of stay (LOS) increased for both discharged patients (9.0 vs. 10.1 vs. 11.2 h, respectively; p < 0.005) and hospitalized patients (7.5 vs. 9.7 vs. 10.6 h, respectively; p < 0.005). During the COVID-19 pandemic, the overall number of stroke diagnoses decreased, while the percentage of patients transported to EDs by EMS vehicles increased. Furthermore, an increased processing time in EDs was highlighted.

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Section: Discussionsupporting

confidence: 65%

Italy’s Post-COVID-19 Stroke Network: Has It Returned to Pre-Pandemic Standards?

Kacerik,

Bottega,

Andreassi

et al. 2024

Epidemiologia

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Epidemiology of abscess and cellulitis among United States emergency departments from 2016 to 2023

Gottlieb,

Bernard

2024

Academic Emergency Medicine

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Changes in emergency department visits and mortality during the COVID-19 pandemic: a retrospective analysis of 956 hospitals

Razimoghadam,

Yaseri,

Effatpanah

et al. 2024

Arch Public Health

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Background During the COVID-19 pandemic, many non-COVID-19 emergency department (ED) visits were indirectly affected. ED visits and mortality were assessed during different pandemic time periods compared with pre-pandemic. Methods The study used data from 41 million Iran Health Insurance Organization members. The outcomes were non-COVID-19 ED visits and associated mortality in 956 hospitals. An analysis of ED visits was conducted both for all-cause and cause-specific conditions: cardiovascular diseases (CVD), mental and substance use disorders, unintentional injuries, and self-harm. In addition, total in-hospital ED mortality was analyzed. A negative binomial regression and a Poisson regression with a log link were used to estimate the incidence rate ratio (IRR) of visits and mortality relative risk (RR). Results 1,789,831 ED visits and 12,377 deaths were reported during the study. Pre-pandemic (Sep 2019 to Feb 2020), there were 2,767 non-COVID-19 visits rate per million person-month, which decreased to 1,884 during the first COVID-19 wave with a national lockdown from Feb 20 to Apr 19, 2020 (IRR 0.68, [0.56–0.84]). The non-COVID-19 ED mortality risk was 8.17 per 1,000 visit-month during the pre-pandemic period, rising to 12.80 during the first wave of COVID-19 (RR 1.57, [1.49–165]). Non-COVID-19 ED visit rates decreased during the first pandemic year from Sep 2020 to Feb 2021 (IRR 0.73, [0.63–0.86]), but increased after COVID-19 vaccination two years later from Sep 2021 to Feb 2022 (IRR 1.11, [0.96–0.17]). The total ED mortality risk for non-COVID-19 was significantly higher after the COVID-19 outbreak in the first (RR 1.66, [1.59–1.72]) and second years (RR 1.27, [1.22–1.32]) of the pandemic. The visit incidence rate for mental health and substance use disorders declined from 8.18 per million person-month to 4.57 (IRR 0.53, [0.32 to 0.90]) in the first wave. In the second year, unintentional injury visits increased significantly compared with pre-pandemic (IRR 1.63, [1.30–2.03]). As compared to before the pandemic, there was no significant change in CVD and self-harm visit rates during the pandemic. Cardiac arrest was the leading cause of death in Iran hospitals’ EDs. Conclusion In the first year of the COVID-19 pandemic, non-COVID-19 hospital ED visits declined and mortality risk increased. Despite two years since the COVID-19 outbreak, non-COVID-19 ED mortality risk remains high.

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Cross-sectional analysis of avoidable emergency department visits before and during the COVID-19 pandemic

Cited by 3 publications

References 16 publications

Italy’s Post-COVID-19 Stroke Network: Has It Returned to Pre-Pandemic Standards?

Italy’s Post-COVID-19 Stroke Network: Has It Returned to Pre-Pandemic Standards?

Epidemiology of abscess and cellulitis among United States emergency departments from 2016 to 2023

Changes in emergency department visits and mortality during the COVID-19 pandemic: a retrospective analysis of 956 hospitals

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