Impact of the SARS-CoV-2 Pandemic on Emergency Department Presentations in an Integrated Health System

Abstract

Objective To quantify the impact of the SARS-CoV-2 pandemic on emergency department volumes and patient presentations, and to evaluate changes in community mortality for the purpose of characterizing new patterns of emergency care utilization. Patients and Methods This is an observational cross-sectional study using electronic health records for emergency department visits in an integrated, multi-hospital system with academic and community practices across four states for visits between March 17 to April 21, 2019, and February 9 to April 21, 2020. We compared numbers and proportions of common and critical chief complaints and diagnoses, triage assessments, throughput, disposition, and selected hospital lengths of stay and out-of-hospital deaths. Results In the period of interest, emergency department visits decreased by nearly 50%. Total number of patients diagnosed with myocardial infarctions, stroke, appendicitis and cholecystitis decreased. The percentage of visits for mental health complaints increased. There was an increase in deaths, driven by out-of-hospital mortality. Conclusion Fewer patients presenting with acute and time-sensitive diagnoses suggests that patients are deferring care, this may be further supported by an increase in out of hospital mortality. Understanding which patients are deferring care and why will allow us to develop outreach strategies and ensure that those in need of rapid assessment and treatment will do so, preventing downstream morbidity and mortality.

Violent trauma as an indirect impact of the COVID-19 pandemic: A systematic review of hospital reported trauma

“…Of these two, one study was limited to examination of cases of pediatric non-accidental trauma. 37 Of the four remaining US-based studies, ranging from 71 to 181 days, three found no change in violent trauma 22 , 32 , 39 and one found increased incidence. 27 …”

“…Neither study assessed changes in violent trauma statistically. 35 , 36 The majority of studies were based in urban locations, with heavy bias towards high-income countries, including the United States (n = 14), 17 , 18 , 19 , 22 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 37 , 38 , 39 Australia (n = 2), 23 , 34 and Western Europe (n = 18). 20 , 21 , 24 , 26 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 Records were examined visually via placement of study results onto a world map.…”

“…Of these two, one study was limited to examination of cases of pediatric non-accidental trauma. 37 Of the four remaining US-based studies, ranging from 71 -181 days, three found no change in violent trauma 22,32,39 and one found increased incidence. 27 Among the nine studies that statistically examined changes in violent trauma (duration 13 -90 days), only the longest study, Salzano and colleagues, noted a decrease in violent trauma.…”

Medium‐term effects of COVID‐19 pandemic on epilepsy: A follow‐up study

“…The collapse of the emergency services in March and April 2020 had a major effect on urgent medical conditions such as heart attacks and stroke, causing treatment delays and increased morbidity and mortality rates. 5 Once a certain normalcy had been restored, studies on the medical and psychological effects of lockdown on patients with chronic illnesses began to emerge. 6,7 The medical community has made enormous efforts to enable and promote the use of telemedicine as a safe way of monitoring patients with stable illness, 8 including those with chronic epilepsy, for whom an array of suitable new technologies exists.…”

A potential impact of the donning and doffing policy on emergency department length of stay during the coronavirus disease 2019 pandemic

“…Overall visits to Italian EDs decreased during the pandemic. This decrease may be explained by several reasons: patients' and their parents' fear of nosocomial infection, continuous warning messages from government authorities, and decrease in infection and injury due to the closure of schools and sports venues [1][2][3][4] . Gaslini institutional COVID-19 guidelines established that every patient asking for a non-scheduled visit to the hospital must pass through the ED, and is regarded as infected until proven otherwise.…”