An Analysis of Changes in Emergency Department Visits After a State Declaration During the Time of COVID-19
Bjorn C Westgard, Matthew W Morgan, Gabriela Vazquez-Benitez, Lauren O Erickson, Michael D Zwank, Bjorn C Westgard, Matthew W Morgan, Gabriela Vazquez-Benitez, Lauren O Erickson, Michael D Zwank
Abstract
Study objective: In the initial period of the coronavirus disease 2019 (COVID-19) pandemic, there has been a substantial decrease in the number of patients seeking care in the emergency department. A first step in estimating the impact of these changes is to characterize the patients, visits, and diagnoses for whom care is being delayed or deferred.
Methods: We conducted an observational study, examining demographics, visit characteristics, and diagnoses for all ED patient visits to an urban level 1 trauma center before and after a state emergency declaration and comparing them with a similar period in 2019. We estimated percent change on the basis of the ratios of before and after periods with respect to 2019 and the decline per week using Poisson regression. Finally, we evaluated whether each factor modified the change in overall ED visits.
Results: After the state declaration, there was a 49.3% decline in ED visits overall, 35.2% (95% confidence interval -38.4 to -31.9) as compared with 2019. Disproportionate declines were seen in visits by pediatric and older patients, women, and Medicare recipients, as well as for presentations of syncope, cerebrovascular accidents, urolithiasis, and abdominal and back pain. Significant proportional increases were seen in ED visits for upper respiratory infections, shortness of breath, and chest pain.
Conclusion: There have been significant changes in patterns of care seeking during the COVID-19 pandemic. Declines in ED visits, especially for certain demographic groups and disease processes, should prompt efforts to understand these phenomena, encourage appropriate care seeking, and monitor for the morbidity and mortality that may result from delayed or deferred care.
Copyright © 2020 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
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References
- Wong L.E., Hawkins J.E., Langness S. Where are all the patients? Addressing Covid-19 fear to encourage sick patients to seek emergency care. NEJM Catal. 2020 Available at:
- Bakst B. Minnesota Public Radio News; March 13, 2020. Walz advises no gatherings over 250 people as MN COVID-19 cases hit 14. Available at:
- Garcia S., Albaghdadi M.S., Meraj P.M. Reduction in ST-segment elevation cardiac catheterization laboratory activations in the United States during COVID-19 pandemic. J Am Coll Cardiol. 2020;75:2871–2872.
- Tam D.F., Cheung K., Lam S. Impact of coronavirus disease 2019 (COVID-19) outbreak on ST-segment–elevation myocardial infarction care in Hong Kong, China. Circ Cardiovasc Qual Outcomes. 2020;13
- Ong CW, Goletti D. Impact of the global COVID-19 outbreak on the management of other communicable diseases. Int J Tuberc Lung Dis. 20201;24:547-548
- Huang Y.T., Lee Y.C., Hsiao C.J. Hospitalization for ambulatory-care-sensitive conditions in Taiwan following the SARS outbreak: a population-based interrupted time series study. J Formos Med Assoc. 2009;108:386–394.
- Rosenbaum L. The untold toll — the pandemic’s effects on patients without Covid-19. N Engl J Med. 2020;382:2368–2371.
- Wu X., Nethery R.C., Sabath B.M. Exposure to air pollution and COVID-19 mortality in the United States. Preprint. medRxiv. 2020 2020.04.05.20054502. .
- American College of Emergency Physicians Amidst COVID-19 concerns, emergency physicians urge public not to delay necessary medical care. Press release. April 15, 2020. Available at:
- Leon D.A., Schkolnikov V.M., Smeeth L. COVID-19: a need for real-time monitoring of weekly excess deaths. Lancet. 2020;395:e81.
Source: PubMed