Examination of the relationship between emergency department presentations and population mortality: a multicenter analysis of emergency department presentations during the COVID-19 pandemic

Abstract

Background : In the spring of 2020, Italy experienced a significant reduction in the number of emergency department (ED) presentations during the first wave of the COVID-19 pandemic. If ED access has an impact on patients’ prognosis, such a reduction in ED presentations would be expected to correlate with a parallel increase in the mortality rate of the corresponding population. The aim of the present study was to evaluate the impact of reduced ED presentations on the all-cause mortality of the general population. Methods Absolute and relative variation in ED accesses from March 1 to April 30 of both 2019 and 2020 in three hub hospitals in areas with different COVID-19 prevalence and age-standardized mortality data from January 1 to June 30 in 2019 and 2020 of the same areas were evaluated. Results : During March and April 2020, ED consults were decreased of approximately 50% in all three hospitals, as compared with the same months in 2019. There was a marked increase in cumulative mortality in Milan (high SARS-CoV2 infection spread zone) compared with the same period in 2019. In the other two municipalities (Ferrara and Perugia), which had intermediate and low levels of infection spread, the mortality in 2020 was not substantially changed from that of 2019. Conclusions : Taking into account the increase in mortality due to SARS-CoV-2, reductions in ED access did not seem to affect death rates. If this finding will be confirmed, ED organization and access would need to be reconsidered.

Epidemiology and clinical characteristics of adult patients presenting to a low resource, tertiary care emergency department in Pakistan: Challenges & Outcomes

“…19 Before the outbreak of COVID-19, patients with age 60-69 years had the most frequent ED visits (45.42%) in Thailand with pneumonia (4.8%), malaise and fatigue (4.5%), and heart failure (4.3%) seen as common pathologies. 5,20 As shown in Fig. 2, the average patient flow per team in the main ED was 7.6 patients in the morning shift and 4.2 in the night shift.…”

“… 19 Before the outbreak of COVID-19, patients with age 60–69 years had the most frequent ED visits (45.42%) in Thailand with pneumonia (4.8%), malaise and fatigue (4.5%), and heart failure (4.3%) seen as common pathologies. 5 , 20 …”

“… 27 Similar results were seen in Milan, Italy with approximately 50% decline during March and April 2020, as compared with the same months in 2019. 20 The marked decline in ED visits of vulnerable elderly population can perhaps be attributed to the effect of lockdown measures and fear of contagion from medical facilities. 28 Necessity of social distancing precautions for older adults may have further isolated and disconnected them from families and caregivers who may have been the primary point of contact for health concerns, including transportation to the ED.…”

Association between stringency of lockdown measures and emergency department visits during the COVID-19 pandemic: A Dutch multicentre study

“…Meanwhile, there were concerns for drastic decreases in ED visits in other patient categories. Early reports from the first months of lockdown in Italy in 2020 showed a reduction in ED visits as high as 68% [ 9 , 10 ]. Similar reductions were reported in other countries such as Germany, the United Kingdom and the United States [ 11 – 13 ].…”

Relationship Between the Duration of the Examination in the Emergency Department and Some Characteristics of the Patients

“…These provisions become even more important with the COVID-19 pandemic. This pandemic allowed us to examine the real situation in the emergency department in terms of patient care and its role in the health system [11,12,13].…”