The Impact of the Covid-19 Outbreak on Emergency Room Attendances of Surgical Patients

The Impact of the Coronavirus Disease 2019 (Covid-19) Outbreak on Emergency Room Attendances of Surgical Patients at a Tertiary Medical Center

Since December 2019, when the novel coronavirus disease (Covid-19) spread throughout the world, data have been needed on the effects of the pandemic on various aspects of healthcare systems. Recommendations for social distancing and quarantine decrees made by local governments, alongside the general public fear from the spread of the virus, are presumed to have markedly affected the trends in hospitals visits. Understanding the exact nature of the effect is critical for better anticipating and preparing health systems in the event of future outbreaks and in the post outbreak period. Therefore we intend to To identify retrospectively all patients who presented to the emergency department at our medical institute between January 1 - March 31 in the following years: 2017, 2018, 2019, 2020. We will examine the impact of COVID-19 on the rates of surgical emergency visits, ratio of surgical visits to non-surgical visits, the ratio of severe presentations to non-severe presentations, and the impact of age on ED attendance.

Study Overview

• Status: Unknown
• Conditions: General Surgery; Emergency Service, Hospital
• Intervention / Treatment: Other: COVID-19 Pandemic

Detailed Description

Since December 2019, when the novel coronavirus disease (Covid-19) spread throughout the world, data have been needed on the effects of the pandemic on various aspects of healthcare systems. Recommendations for social distancing and quarantine decrees made by local governments, alongside the general public fear from the spread of the virus, are presumed to have markedly affected the trends in hospitals visits. Understanding the exact nature of the effect is critical for better anticipating and preparing health systems in the event of future outbreaks and in the post outbreak period. Additionally, deferring hospitals visits can potentially put patients at increased risk for morbidity and mortality, especially in postsurgical patients. Evaluating the impact of the pandemic on patient volume can guide decision-making in future scenarios.

Previous infectious disease outbreaks have been shown to impact ED volumes: The US Hantavirus outbreak in 1993 led to a 2-fold increase in ED visits; Escherichia coli 0157:H7 outbreak in Washington state in 1993 increased ED visits by 17%; However, the 2003 SARS outbreaks in Hong Kong, Taiwan, and Toronto reduced tertiary care ED visits by up to 47 percent.

• Study Type: Observational
• Enrollment (Anticipated): 10000

Contacts and Locations

Study Locations

• Israel
  • Ramat Gan, Israel
    • Recruiting
    • Sheba Medical Center
    • Contact: Roi Anteby, MD; Phone Number: +972545882207; Email: roi.anteby@sheba.health.gov.il

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

All patients aged >18 years old who attended the emergency department of Sheba Medical Center between January 1 - March 31 in the following years: 2017, 2018, 2019, 2020

Description

Inclusion Criteria:

• All patients visiting the ER of Sheba Medical Center between January 1 - March 31 in the following years: 2017, 2018, 2019, 2020

Exclusion Criteria:

• Patients less than 18 years of age

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Pandemic Period; Patients who presented to the emergency department at our medical institute Sheba Medical Center between January 1 - March 31 in 2020.	Other: COVID-19 Pandemic; Exposure: the novel coronavirus disease (Covid-19) outbreak
Pre Pandemic Period; Patients who presented to the emergency department at our medical institute Sheba Medical Center between January 1 - March 31 in the following years: 2017, 2018, 2019,

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Rates of emergency visits needing surgical consult	January 1 - March 31 in the following years: 2017, 2018, 2019, 2020
The ratio of severe presentations to non-severe presentations	January 1 - March 31 in the following years: 2017, 2018, 2019, 2020

Secondary Outcome Measures

Outcome Measure	Time Frame
The impact of age on ED attendance rates	January 1 - March 31 in the following years: 2017, 2018, 2019, 2020
Differences in ED surgical visits (in terms of capacity and severity) of surgical patients depending on the presentation and the co morbidity	January 1 - March 31 in the following years: 2017, 2018, 2019, 2020

Collaborators and Investigators

• Sponsor: Sheba Medical Center

Publications and helpful links

General Publications

• Heiber M, Lou WY. Effect of the SARS outbreak on visits to a community hospital emergency department. CJEM. 2006 Sep;8(5):323-8. doi: 10.1017/s148180350001397x.
• Chen WK, Cheng YC, Chung YT, Lin CC. The impact of the SARS outbreak on an urban emergency department in Taiwan. Med Care. 2005 Feb;43(2):168-72. doi: 10.1097/00005650-200502000-00010.
• Anteby R, Zager Y, Barash Y, Nadler R, Cordoba M, Klang E, Klein Y, Ram E, Gutman M, Horesh N. The Impact of the Coronavirus Disease 2019 Outbreak on the Attendance of Patients with Surgical Complaints at a Tertiary Hospital Emergency Department. J Laparoendosc Adv Surg Tech A. 2020 Sep;30(9):1001-1007. doi: 10.1089/lap.2020.0465. Epub 2020 Jun 23.

Study record dates

Study Major Dates

• Study Start (Actual): April 5, 2020
• Primary Completion (Anticipated): April 1, 2021
• Study Completion (Anticipated): April 1, 2022

Study Registration Dates

• First Submitted: April 4, 2020
• First Submitted That Met QC Criteria: April 7, 2020
• First Posted (Actual): April 8, 2020

Study Record Updates

• Last Update Posted (Actual): April 21, 2020
• Last Update Submitted That Met QC Criteria: April 19, 2020
• Last Verified: April 1, 2020

More Information

Terms related to this study

• Keywords: Surgery; Covid-19; Emergency
• Additional Relevant MeSH Terms: Pathologic Processes; Coronavirus Infections; Coronaviridae Infections; Nidovirales Infections; RNA Virus Infections; Virus Diseases; Infections; Respiratory Tract Infections; Respiratory Tract Diseases; Pneumonia, Viral; Pneumonia; Lung Diseases; Disease Attributes; COVID-19; Emergencies
• Other Study ID Numbers: SMC-20-7078-YZ-CTIL

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No