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Jurado-Palomo J, Sanz-García A, Martín-Conty JL, Polonio-López B, López-Izquierdo R, Sáez-Belloso S, Del Pozo Vegas C, Martín-Rodríguez F. Prehospital point-of-care medication burden as a predictor of poor related outcomes in unselected acute diseases. Intern Emerg Med 2024:10.1007/s11739-024-03729-x. [PMID: 39090370 DOI: 10.1007/s11739-024-03729-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 07/26/2024] [Indexed: 08/04/2024]
Abstract
How prehospital medication predicts patient outcomes is unclear. The aim of this work was to unveil the association between medication burden administration in prehospital care and short, mid, and long-term mortality (2, 30, and 365 day) in unselected acute diseases and to assess the potential of the number of medications administered for short, mid, and long-term mortality prediction. A prospective, multicenter, ambulance-based, cohort study was carried out in adults with unselected acute diseases managed by emergency medical services (EMS). The study was carried out in Spain with 44 ambulances and four hospitals. The principal outcome was cumulative mortality at 2, 30, and 365 days. Epidemiological variables, vital signs, and prehospital medications were collected. Patients were classified into four categories: no medication dispensed in prehospital care, one to two medications, three to four medications, and five or more medications. A total of 6401 patients were selected. The 2-day mortality associated with each group was 0.5%, 1.8%, 6.5%, and 18.8%. The 30-day mortality associated with each group was 3.8%, 6.2%, 13.5%, and 31.9%. The 365-day mortality associated with each group was 11%, 15.3%, 25.2%, and 45.7%. The predictive validity of the number of drugs administered, measured by the area under the curve, was 0.808, 0.720, and 0.660 for 2-, 30-, and 365-day mortality, respectively. Our results showed that prehospital drugs could provide relevant information regarding the mortality prediction of patients. The incorporation of this score could improve the management of high-risk patients by the EMS.
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Affiliation(s)
- Jesús Jurado-Palomo
- Grupo de Investigación ITAS, Faculty of Health Sciences, Universidad de Castilla la Mancha, Avda. Real Fábrica de Seda, s/n, 45600, Talavera de la Reina, Spain
- Hospital General Nuestra Señora del Prado, Talavera de la Reina, Spain
| | - Ancor Sanz-García
- Grupo de Investigación ITAS, Faculty of Health Sciences, Universidad de Castilla la Mancha, Avda. Real Fábrica de Seda, s/n, 45600, Talavera de la Reina, Spain.
| | - José Luis Martín-Conty
- Grupo de Investigación ITAS, Faculty of Health Sciences, Universidad de Castilla la Mancha, Avda. Real Fábrica de Seda, s/n, 45600, Talavera de la Reina, Spain
| | - Begoña Polonio-López
- Grupo de Investigación ITAS, Faculty of Health Sciences, Universidad de Castilla la Mancha, Avda. Real Fábrica de Seda, s/n, 45600, Talavera de la Reina, Spain
| | - Raúl López-Izquierdo
- Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
- Faculty of Medicine, University of Valladolid, Valladolid, Spain
| | - Silvia Sáez-Belloso
- Prehospital Emergency Medical Services (SACYL), Valladolid, Spain
- Faculty of Nursing, Universidad de Valladolid, Valladolid, Spain
| | - Carlos Del Pozo Vegas
- Faculty of Medicine, University of Valladolid, Valladolid, Spain
- Emergency Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Francisco Martín-Rodríguez
- Faculty of Medicine, University of Valladolid, Valladolid, Spain
- Prehospital Emergency Medical Services (SACYL), Valladolid, Spain
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Enriquez de Salamanca Gambara R, Sanz-García A, del Pozo Vegas C, López-Izquierdo R, Sánchez Soberón I, Delgado Benito JF, Martínez Diaz R, Pérez-Oleaga CM, López NMM, Domínguez Azpíroz I, Martín-Rodríguez F. A Comparison of the Clinical Characteristics of Short-, Mid-, and Long-Term Mortality in Patients Attended by the Emergency Medical Services: An Observational Study. Diagnostics (Basel) 2024; 14:1292. [PMID: 38928707 PMCID: PMC11203341 DOI: 10.3390/diagnostics14121292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/14/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024] Open
Abstract
AIM The development of predictive models for patients treated by emergency medical services (EMS) is on the rise in the emergency field. However, how these models evolve over time has not been studied. The objective of the present work is to compare the characteristics of patients who present mortality in the short, medium and long term, and to derive and validate a predictive model for each mortality time. METHODS A prospective multicenter study was conducted, which included adult patients with unselected acute illness who were treated by EMS. The primary outcome was noncumulative mortality from all causes by time windows including 30-day mortality, 31- to 180-day mortality, and 181- to 365-day mortality. Prehospital predictors included demographic variables, standard vital signs, prehospital laboratory tests, and comorbidities. RESULTS A total of 4830 patients were enrolled. The noncumulative mortalities at 30, 180, and 365 days were 10.8%, 6.6%, and 3.5%, respectively. The best predictive value was shown for 30-day mortality (AUC = 0.930; 95% CI: 0.919-0.940), followed by 180-day (AUC = 0.852; 95% CI: 0.832-0.871) and 365-day (AUC = 0.806; 95% CI: 0.778-0.833) mortality. DISCUSSION Rapid characterization of patients at risk of short-, medium-, or long-term mortality could help EMS to improve the treatment of patients suffering from acute illnesses.
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Affiliation(s)
| | - Ancor Sanz-García
- Faculty of Health Sciences, Universidad de Castilla la Mancha, 45600 Talavera de la Reina, Spain
| | - Carlos del Pozo Vegas
- Faculty of Medicine, Universidad de Valladolid, 47011 Valladolid, Spain; (C.d.P.V.); (F.M.-R.)
- Emergency Department, Hospital Clínico Universitario, 47003 Valladolid, Spain
| | - Raúl López-Izquierdo
- Emergency Department, Hospital Universitario Rio Hortega, 47012 Valladolid, Spain; (R.E.d.S.G.); (R.L.-I.)
- Faculty of Medicine, Universidad de Valladolid, 47011 Valladolid, Spain; (C.d.P.V.); (F.M.-R.)
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, 28029 Madrid, Spain
| | - Irene Sánchez Soberón
- Advanced Life Support, Emergency Medical Services (SACYL), 47007 Valladolid, Spain; (I.S.S.); (J.F.D.B.)
| | - Juan F. Delgado Benito
- Advanced Life Support, Emergency Medical Services (SACYL), 47007 Valladolid, Spain; (I.S.S.); (J.F.D.B.)
| | - Raquel Martínez Diaz
- Department of Project Management, Universidad Europea del Atlántico, 39011 Santander, Spain; (R.M.D.); (C.M.P.-O.); (N.M.M.L.); (I.D.A.)
- Department of Project Management, Universidad Internacional Iberoamericana, Campeche 24560, Mexico
- Department of Project Management, Universidad de La Romana, La Romana 22000, Dominican Republic
| | - Cristina Mazas Pérez-Oleaga
- Department of Project Management, Universidad Europea del Atlántico, 39011 Santander, Spain; (R.M.D.); (C.M.P.-O.); (N.M.M.L.); (I.D.A.)
- Department of Project Management, Universidad Internacional Iberoamericana, Arecibo 00613, Puerto Rico
- Department of Project Management, Universidade Internacional do Cuanza, Cuito EN250, Angola
| | - Nohora Milena Martínez López
- Department of Project Management, Universidad Europea del Atlántico, 39011 Santander, Spain; (R.M.D.); (C.M.P.-O.); (N.M.M.L.); (I.D.A.)
- Department of Project Management, Universidad Internacional Iberoamericana, Campeche 24560, Mexico
- Fundación Universitaria Internacional de Colombia, Bogotá 111321, Colombia
| | - Irma Domínguez Azpíroz
- Department of Project Management, Universidad Europea del Atlántico, 39011 Santander, Spain; (R.M.D.); (C.M.P.-O.); (N.M.M.L.); (I.D.A.)
- Department of Project Management, Universidad Internacional Iberoamericana, Campeche 24560, Mexico
- Department of Project Management, Universidad de La Romana, La Romana 22000, Dominican Republic
| | - Francisco Martín-Rodríguez
- Faculty of Medicine, Universidad de Valladolid, 47011 Valladolid, Spain; (C.d.P.V.); (F.M.-R.)
- Advanced Life Support, Emergency Medical Services (SACYL), 47007 Valladolid, Spain; (I.S.S.); (J.F.D.B.)
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Donnelly MR, Barie PS, Schubl SD. Impact of the Coronavirus Disease 2019 Pandemic on Utilization of Emergency Medical Services in New York City. Surg Infect (Larchmt) 2024; 25:95-100. [PMID: 38294840 DOI: 10.1089/sur.2023.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Abstract
Background: This study evaluates trends in the utilization of emergency medical services (EMS) in New York City, the "epicenter" of the first "wave" of the coronavirus pandemic. We hypothesize that EMS call volumes decreased overall in New York City during the first year of the pandemic, specifically with respect to trauma/injury calls. Contrarily, we posit that calls for "sick" events increased given pervasive fear of virus transmission. Materials and Methods: Retrospective New York City EMS calls data (January 1, 2019 to December 31, 2020) were obtained from the NYC Open Data/EMS Incident Dispatch database. Total EMS calls, trauma/injury calls, and "sick" event calls were collected for New York City and for all five boroughs. Census data for each borough were used to weigh daily EMS calls per 100,000 individuals. Mann-Whitney U tests were used to compare pre-pandemic (2019 to March 2020) versus pandemic (April 2020 to December 2020) EMS call volumes, p = 0.05. Results: Median daily EMS calls per 100,000 individuals decreased 21.6% at the start of the pandemic across New York City (pre-pandemic, 3,262 calls; pandemic, 2,556 calls; p < 0.001) and similarly decreased when stratified by borough (all, p < 0.001). Median daily trauma/injury and sick event calls per 100,000 also decreased in New York City and the five boroughs from pre-pandemic to pandemic time periods (all, p < 0.001). Discussion and Conclusions: These data reflect an unprecedented window into EMS utilization during an infectious disease pandemic. As decreased EMS utilization for multiple conditions likely reflects delayed or impeded access to care, utilization data have important implications for provision of acute care services during possible future disruptions related to the pandemic.
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Affiliation(s)
- Megan R Donnelly
- Department of Surgery, UC Irvine Health, Orange, California, USA
| | - Philip S Barie
- Department of Surgery, Weill Cornell Medicine, New York, New York, USA
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Razimoghadam M, Yaseri M, Effatpanah M, Daroudi R. Changes in emergency department visits and mortality during the COVID-19 pandemic: a retrospective analysis of 956 hospitals. Arch Public Health 2024; 82:5. [PMID: 38216989 PMCID: PMC10785366 DOI: 10.1186/s13690-023-01234-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/26/2023] [Indexed: 01/14/2024] Open
Abstract
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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Affiliation(s)
- Mahya Razimoghadam
- Department of Health Management, policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Effatpanah
- Pediatric department, School of Medicine, Imam Khomeini hospital, Tehran University of Medical Sciences, Tehran, Iran
- National Center for Health Insurance Research, Tehran, Iran
| | - Rajabali Daroudi
- Department of Health Management, policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Zalama-Sánchez D, Martín-Rodríguez F, López-Izquierdo R, Benito JFD, Soberón IS, Vegas CDP, Sanz-García A. Prehospital Targeting of 1-Year Mortality in Acute Chest Pain by Cardiac Biomarkers. Diagnostics (Basel) 2023; 13:3681. [PMID: 38132265 PMCID: PMC10743255 DOI: 10.3390/diagnostics13243681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
The identification and appropriate management of patients at risk of suffering from acute chest pain (ACP) in prehospital care are not straightforward. This task could benefit, as occurs in emergency departments (EDs), from cardiac enzyme assessment. The aim of the present work was to derive and validate a scoring system based on troponin T (cTnT), N-terminal pro B-type natriuretic peptide (NT-proBNP), and D-dimer to predict 1-year mortality in patients with ACP. This was a prospective, multicenter, ambulance-based cohort study of adult patients with a prehospital ACP diagnosis who were evacuated by ambulance to the ED between October 2019 and July 2021. The primary outcome was 365-day cumulative mortality. A total of 496 patients fulfilled the inclusion criteria. The mortality rate was 12.1% (60 patients). The scores derived from cTnT, NT-proBNP, and D-dimer presented an AUC of 0.802 (95% CI: 0718-0.886) for 365-day mortality. This AUC was superior to that of each individual cardiac enzyme. Our study provides promising evidence for the predictive value of a risk score based on cTnT, NT-proBNP, and D-dimer for the prediction of 1-year mortality in patients with ACP. The implementation of this score has the potential to benefit emergency medical service care and facilitate the on-scene decision-making process.
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Affiliation(s)
- Daniel Zalama-Sánchez
- Servicio de Urgencias, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), 47007 Valladolid, Spain; (D.Z.-S.); (C.d.P.V.)
| | - Francisco Martín-Rodríguez
- Facultad de Medicina, Universidad de Valladolid, Gerencia de Emergencias Sanitarias, Gerencia Regional de Salud de Castilla y León (SACYL), 47007 Valladolid, Spain
| | - Raúl López-Izquierdo
- Servicio de Urgencias, Hospital Universitario Rio Hortega de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), 47007 Valladolid, Spain;
| | - Juan F. Delgado Benito
- Gerencia de Emergencias Sanitarias, Gerencia Regional de Salud de Castilla y León (SACYL), 47007 Valladolid, Spain; (J.F.D.B.); (I.S.S.)
| | - Irene Sánchez Soberón
- Gerencia de Emergencias Sanitarias, Gerencia Regional de Salud de Castilla y León (SACYL), 47007 Valladolid, Spain; (J.F.D.B.); (I.S.S.)
| | - Carlos del Pozo Vegas
- Servicio de Urgencias, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), 47007 Valladolid, Spain; (D.Z.-S.); (C.d.P.V.)
| | - Ancor Sanz-García
- Grupo de Investigación en Innovación Tecnológica Aplicada a la Salud (Grupo ITAS), Facultad de Ciencias de la Salud, Universidad de Castilla la Mancha, 13071 Talavera de la Reina, Spain;
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Oskvarek JJ, Zocchi MS, Black BS, Celedon P, Leubitz A, Moghtaderi A, Nikolla DA, Rahman N, Pines JM. Emergency Department Volume, Severity, and Crowding Since the Onset of the Coronavirus Disease 2019 Pandemic. Ann Emerg Med 2023; 82:650-660. [PMID: 37656108 DOI: 10.1016/j.annemergmed.2023.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/28/2023] [Accepted: 07/24/2023] [Indexed: 09/02/2023]
Abstract
STUDY OBJECTIVE We describe emergency department (ED) visit volume, illness severity, and crowding metrics from the onset of the coronavirus disease 2019 (COVID-19) pandemic through mid-2022. METHODS We tabulated monthly data from 14 million ED visits on ED volumes and measures of illness severity and crowding from March 2020 through August 2022 compared with the same months in 2019 in 111 EDs staffed by a national ED practice group in 18 states. RESULTS Average monthly ED volumes fell in the early pandemic, partially recovered in 2022, but remained below 2019 levels (915 per ED in 2019 to 826.6 in 2022 for admitted patients; 3,026.9 to 2,478.5 for discharged patients). The proportion of visits assessed as critical care increased from 7.9% in 2019 to 11.0% in 2022, whereas the number of visits decreased (318,802 to 264,350). Visits billed as 99285 (the highest-acuity Evaluation and Management code for noncritical care visits) increased from 35.4% of visits in 2019 to 40.0% in 2022, whereas the number of visits decreased (1,434,454 to 952,422). Median and median of 90th percentile length of stay for admitted patients rose 32% (5.2 to 6.9 hours) and 47% (11.7 to 17.4 hours) in 2022 versus 2019. Patients leaving without treatment rose 86% (2.9% to 5.4%). For admitted psychiatric patients, the 90th percentile length of stay increased from 20 hours to more than 1 day. CONCLUSION ED visit volumes fell early in the pandemic and have only partly recovered. Despite lower volumes, ED crowding has increased. This issue is magnified in psychiatric patients.
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Affiliation(s)
- Jonathan J Oskvarek
- US Acute Care Solutions, Canton, OH; Department of Emergency Medicine, Summa Health System, Akron, OH.
| | - Mark S Zocchi
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA
| | - Bernard S Black
- Pritzker School of Law, Northwestern University, Chicago, IL
| | | | | | - Ali Moghtaderi
- Department of Health Policy and Management, the Milken Institute School of Public Health, George Washington University, Washington, DC
| | | | - Nishad Rahman
- Department of Emergency Medicine, Sinai Hospital, Baltimore, MD
| | - Jesse M Pines
- US Acute Care Solutions, Canton, OH; Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA
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Morales C, Bruckner TA, Du S, Young A, Ro A. Changes in Acute ED Visits by Race/Ethnicity During the Early COVID-19 Pandemic. J Immigr Minor Health 2023; 25:1286-1294. [PMID: 37269403 PMCID: PMC10239213 DOI: 10.1007/s10903-023-01499-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/05/2023]
Abstract
Emergency department (ED) visits for conditions unrelated to the Coronavirus Disease 2019 (COVID-19) pandemic decreased during the early pandemic, raising concerns about critically ill patients forgoing care and increasing their risk of adverse outcomes. It is unclear if Hispanic and Black adults, who have a high prevalence of chronic conditions, sought medical assistance for acute emergencies during this time. This study used 2018-2020 ED visit data from the largest safety net hospital in Los Angeles County to estimate ED visit differences for cardiac emergencies, diabetic complications, and strokes, during the first societal lockdown among Black and Hispanic patients using time series analyses. Emergency department visits were lower than the expected levels during the first societal lockdown. However, after the lockdown ended, Black patients experienced a rebound in ED visits while visits for Hispanics remained depressed. Future research could identify barriers Hispanics experienced that contributed to prolonged ED avoidance.
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Affiliation(s)
- Celina Morales
- Department of Population Health and Disease Prevention, University of California Irvine, 653 E. Peltason Dr, Irvine, CA, 92697-3957, USA.
| | - Tim A Bruckner
- Department of Health, Society, and Behavior, University of California Irvine, Irvine, CA, USA
| | - Senxi Du
- Department of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andrew Young
- Harbor UCLA Medical Center, Los Angeles, CA, USA
| | - Annie Ro
- Department of Health, Society, and Behavior, University of California Irvine, Irvine, CA, USA
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Bennani H, Guennouni M, Ouarradi AE, Hanchi AL, Soraa N. Microbiological profile of multidrug resistant bacteria before and during COVID-19 in CHU Mohammed VI. IRANIAN JOURNAL OF MICROBIOLOGY 2023; 15:771-778. [PMID: 38156298 PMCID: PMC10751609 DOI: 10.18502/ijm.v15i6.14138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
Background and Objectives A new type of corona virus has caused Corona virus disease-19 and, subsequently, a global pandemic. All individuals are prone to the disease, so drastic measures were taken to prevent its spread. This study aimed to evaluate the impact of COVID-19 on the progression of the antimicrobial resistance rate by comparing two periods: before and during COVID-19. Materials and Methods We used a cross-sectional design to investigate the Antimicrobial Resistance (AMR) rate before (03/2019 to 03/2020) and during COVID-19 (03/2020 to 03/2021) in a University Hospital in Marrakech. The data were analyzed using SPSS Version 25.0. Results Among the 7106 specimens, there was a significant increase in the multidrug-resistant bacterial from 27.38% to 35.87% during COVID-19 (p<0.001), particularly in blood culture, cerebrospinal fluid, catheter, and pus. However, there was a non-significant change in puncture fluid, expectoration, protected distal sampling, joint fluid, stool culture, and genital sampling. A decrease in Multidrug-resistant bacteria (MDRB) was observed only in cytobacteriological urine tests (p<0.05). According to species, there was an increase in extended-spectrum beta-lactamase-producing Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae, and methicillin-resistant Staphylococcus aureus. Conclusion In our study, it is particularly noticeable that the MDRB has increased. These results highlight the importance that the pandemic has not been able to slow the progression.
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Affiliation(s)
- Hind Bennani
- Laboratory of Microbiology, Mohamed VI University Hospital Center, Marrakesh, Morocco
- Laboratory of Microbiology, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco
| | - Morad Guennouni
- Department of Science and Technology Team, Higher School of Education and Training, Chouaib Doukkali University, El Jadida, Morocco
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences of Settat, Hassan First University of Settat, Settat, Morocco
| | - Assia El Ouarradi
- Laboratory of Microbiology, Mohamed VI University Hospital Center, Marrakesh, Morocco
- Laboratory of Microbiology, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco
| | - Asmae Lamrani Hanchi
- Laboratory of Microbiology, Mohamed VI University Hospital Center, Marrakesh, Morocco
- Laboratory of Microbiology, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco
| | - Nabila Soraa
- Laboratory of Microbiology, Mohamed VI University Hospital Center, Marrakesh, Morocco
- Laboratory of Microbiology, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco
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Rahman N, Pines JM. What we can learn from paediatric ED visit changes during pandemics and epidemics. Evid Based Nurs 2023; 26:146. [PMID: 36914230 DOI: 10.1136/ebnurs-2022-103656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 03/16/2023]
Affiliation(s)
- Nishad Rahman
- Department of Emergency Medicine, LifeBridge Health, Baltimore, Maryland, USA
| | - Jesse M Pines
- Department of Emergency Medicine, US Acute Care Solutions; Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
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Garcia-Ptacek S, Xu H, Annetorp M, Jerlardtz VB, Cederholm T, Engström M, Kivipelto M, Lundberg LG, Metzner C, Olsson M, Nyvang JS, Sühl Öberg C, Åkesson E, Religa D, Eriksdotter M. Temporal trends in hospitalizations and 30-day mortality in older patients during the COVID pandemic from March 2020 to July 2021. PLoS One 2023; 18:e0291237. [PMID: 37708110 PMCID: PMC10501674 DOI: 10.1371/journal.pone.0291237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/24/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND A reduction in mortality risk of COVID-19 throughout the first wave of the pandemic has been reported, but less is known about later waves. This study aimed to describe changes in hospitalizations and mortality of patients receiving inpatient geriatric care for COVID-19 or other causes during the pandemic. METHODS Patients 70 years and older hospitalized in geriatric hospitals in Stockholm for COVID-19 or other causes between March 2020-July 2021 were included. Data on the incidence of COVID-positive cases and 30-day mortality of the total ≥ 70-year-old population, in relation to weekly hospitalizations and mortality after hospital admissions were analyzed. Findings The total number of hospitalizations was 5,320 for COVID-19 and 32,243 for non-COVID-cases. In COVID-patients, the 30-day mortality rate was highest at the beginning of the first wave (29% in March-April 2020), reached 17% at the second wave peak (November-December) followed by 11-13% in the third wave (March-July 2021). The mortality in non-COVID geriatric patients showed a similar trend, but of lower magnitude (5-10%). During the incidence peaks, COVID-19 hospitalizations displaced non-COVID geriatric patients. INTERPRETATION Hospital admissions and 30-day mortality after hospitalizations for COVID-19 increased in periods of high community transmission, albeit with decreasing mortality rates from wave 1 to 3, with a probable vaccination effect in wave 3. Thus, the healthcare system could not compensate for the high community spread of COVID-19 during the pandemic peaks, which also led to displacing care for non-COVID geriatric patients.
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Affiliation(s)
- Sara Garcia-Ptacek
- Department of Neurobiology, Division of Clinical Geriatrics, Karolinska Institutet, Care Sciences and Society, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Hong Xu
- Department of Neurobiology, Division of Clinical Geriatrics, Karolinska Institutet, Care Sciences and Society, Stockholm, Sweden
| | - Martin Annetorp
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | | | - Tommy Cederholm
- Department of Neurobiology, Division of Clinical Geriatrics, Karolinska Institutet, Care Sciences and Society, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Malin Engström
- Department of Geriatric Medicine, Sabbatsbergsgeriatriken, Stockholm, Sweden
| | - Miia Kivipelto
- Department of Neurobiology, Division of Clinical Geriatrics, Karolinska Institutet, Care Sciences and Society, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Göran Lundberg
- Department of Geriatric Medicine, Dalengeriatriken Aleris Närsjukvård AB, Stockholm, Sweden
| | - Carina Metzner
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Olsson
- Department of Geriatric Medicine, Capio Geriatrik Löwet, Stockholm, Sweden
- Department of Geriatric Medicine, Capio Geriatrik Sollentuna, Stockholm, Sweden
| | | | - Carina Sühl Öberg
- Department of Geriatric Medicine, Handengeriatriken, Aleris Närsjukvård AB, Stockholm, Sweden
| | - Elisabet Åkesson
- Department of Neurobiology, Division of Neurogeriatrics, Karolinska Institutet, Care Sciences and Society, Stockholm, Sweden
- R&D Unit, Stockholms Sjukhem, Stockholm, Sweden
| | - Dorota Religa
- Department of Neurobiology, Division of Clinical Geriatrics, Karolinska Institutet, Care Sciences and Society, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Eriksdotter
- Department of Neurobiology, Division of Clinical Geriatrics, Karolinska Institutet, Care Sciences and Society, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
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11
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Moghtaderi A, Zocchi MS, Pines JM, Venkat A, Black B. Estimating the uncertain effect of the COVID pandemic on drug overdoses. PLoS One 2023; 18:e0281227. [PMID: 37561686 PMCID: PMC10414597 DOI: 10.1371/journal.pone.0281227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/16/2023] [Indexed: 08/12/2023] Open
Abstract
OBJECTIVE U.S. drug-related overdose deaths and Emergency Department (ED) visits rose in 2020 and again in 2021. Many academic studies and the news media attributed this rise primarily to increased drug use resulting from the societal disruptions related to the coronavirus (COVID-19) pandemic. A competing explanation is that higher overdose deaths and ED visits may have reflected a continuation of pre-pandemic trends in synthetic-opioid deaths, which began to rise in mid-2019. We assess the evidence on whether increases in overdose deaths and ED visits are likely to be related primarily to the COVID-19 pandemic, increased synthetic-opioid use, or some of both. METHODS We use national data from the Centers for Disease Control and Prevention (CDC) on rolling 12-month drug-related deaths (2015-2021); CDC data on monthly ED visits (2019-September 2020) for EDs in 42 states; and ED visit data for 181 EDs in 24 states staffed by a national ED physician staffing group (January 2016-June 2022). We study drug overdose deaths per 100,000 persons during the pandemic period, and ED visits for drug overdoses, in both cases compared to predicted levels based on pre-pandemic trends. RESULTS Mortality. National overdose mortality increased from 21/100,000 in 2019 to 26/100,000 in 2020 and 30/100,000 in 2021. The rise in mortality began in mid-to-late half of 2019, and the 2020 increase is well-predicted by models that extrapolate pre-pandemic trends for rolling 12-month mortality to the pandemic period. Placebo analyses (which assume the pandemic started earlier or later than March 2020) do not provide evidence for a change in trend in or soon after March 2020. State-level analyses of actual mortality, relative to mortality predicted based on pre-pandemic trends, show no consistent pattern. The state-level results support state heterogeneity in overdose mortality trends, and do not support the pandemic being a major driver of overdose mortality. ED visits. ED overdose visits rose during our sample period, reflecting a worsening opioid epidemic, but rose at similar rates during the pre-pandemic and pandemic periods. CONCLUSION The reasons for rising overdose mortality in 2020 and 2021 cannot be definitely determined. We lack a control group and thus cannot assess causation. However, the observed increases can be largely explained by a continuation of pre-pandemic trends toward rising synthetic-opioid deaths, principally fentanyl, that began in mid-to-late 2019. We do not find evidence supporting the pandemic as a major driver of rising mortality. Policymakers need to directly address the synthetic opioid epidemic, and not expect a respite as the pandemic recedes.
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Affiliation(s)
- Ali Moghtaderi
- Milken Institute School of Public Health, George Washington University, Washington, DC, United States of America
| | - Mark S. Zocchi
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, United States of America
| | - Jesse M. Pines
- US Acute Care Solutions, Canton, Ohio, United States of America
- Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, United States of America
| | - Arvind Venkat
- US Acute Care Solutions, Canton, Ohio, United States of America
- Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, United States of America
| | - Bernard Black
- Pritzker School of Law, Northwestern University, Evanston, Illinois, United States of America
- Kellogg School of Management, Northwestern University, Evanston, Illinois, United States of America
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12
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Jäntti S, Ponkilainen V, Kuitunen I, Uimonen MM, Huttunen T, Mattila VM. Intensive care unit admissions with and without COVID-19 in Finland from 2017 to 2021: a retrospective register-based study. BMC Anesthesiol 2023; 23:251. [PMID: 37488508 PMCID: PMC10367372 DOI: 10.1186/s12871-023-02207-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 07/14/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND After the COVID-19 pandemic started, critical care resources were expanded in Finland to manage a possible surge in patients requiring intensive care. The aim of this study was to evaluate the incidence of overall ICU admissions, patient diagnoses, characteristics, and length of stay during the pandemic. METHODS This retrospective hospital register-based study was conducted in two large and one mid-size Finnish public hospitals. The required data were collected from ICU patient information systems and all adult patients were included. Monthly and yearly incidences with 95% confidence intervals (CI) were counted per 100 000 persons-years by Poisson exact method and compared by incidence rate ratios (IRR). RESULTS A total of 4407 admissions to ICUs for any cause occurred during 2020. In 2021, this figure was 4931. During the reference years (2017-2019), the mean number of admissions to ICU was 4781. In 2020 and 2021, the proportion of patients requiring intensive care due to COVID-19 was only 3%. The incidence of all-cause ICU admissions decreased during the lockdown in 2020 when compared to the reference years. Before the start of the lockdown in February 2020, the IRR of all-cause ICU admissions was 1.02 (CI: 0.89 to 1.18). During the lockdown period, however, the IRR of all-cause ICU admissions decreased to 0.78 (CI: 0.67 to 0.90) in March. When the lockdown ended, the incidence rebounded to the same level as before the lockdown. However, in 2021, the incidence of ICU admissions remained at the same level when compared to the reference years. The most prominent changes occurred in the incidence of diseases of the nervous system, which includes epilepsy and seizures and transient cerebral ischemic attacks, in diseases of the respiratory system, and neoplasms. CONCLUSIONS According to the findings of this study, the incidence of all-cause ICU admissions decreased after the lockdown was implemented in 2020. Furthermore, the percentage of patients requiring intensive care due to COVID-19 in Finland was only 3% in 2020 and 2021. These findings may serve to help in the planning and allocating of ICU resources during future pandemics.
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Affiliation(s)
- Saara Jäntti
- Faculty of Medicine and Health Technology, Tampere University, Kauppi Campus, Arvo Ylpön katu 34, Tampere, 33520, Finland.
| | - Ville Ponkilainen
- Department of Surgery, Central Finland Hospital Nova, Hoitajantie 3, 40620, Jyväskylä, Finland
| | - Ilari Kuitunen
- Mikkeli Central Hospital, Porrassalmenkatu 35-37, Mikkeli, 50100, Finland
- School of Medicine, University of Eastern Finland, Yliopistonranta 1, Kuopio, 70211, Finland
| | - Mikko M Uimonen
- Department of Surgery, Central Finland Hospital Nova, Hoitajantie 3, 40620, Jyväskylä, Finland
| | - Tuomas Huttunen
- Department of Cardiothoracic Anesthesia, Tampere Heart Hospital, Teiskontie 35, Tampere, 33521, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Technology, Tampere University, Kauppi Campus, Arvo Ylpön katu 34, Tampere, 33520, Finland
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Teiskontie 35, Tampere, PL2000, 33521, Finland
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13
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Venkatesh AK, Janke AT, Koski-Vacirca R, Rothenberg C, Parwani V, Granovsky MA, Burke LG, Li SX, Pines JM. Estimated reimbursement impact of COVID-19 on emergency physicians. Acad Emerg Med 2023. [PMID: 36820470 DOI: 10.1111/acem.14700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/01/2023] [Accepted: 02/14/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND The delivery and financing of health care services were altered in unprecedented ways by COVID-19 and subsequent policy responses. We estimated reimbursement losses to emergency physicians in 2020 compared to 2019 related to shifting acute care utilization during COVID-19. METHODS This was an observational analysis of the Clinical Emergency Department Registry (CEDR) and the Nationwide Emergency Department Sample (NEDS). Study sample included all ED visits from a sample of 214 emergency department (ED) sites in the CEDR in 2019 and 2020 as well as all ED visits in the NEDS in 2019. We identified level of service billing code for evaluation and management (E&M) services, insurance payer, and geographic location of ED visits across sites in the CEDR and linked these to fee schedules to estimate total professional reimbursement across sites. Our primary analysis was to estimate reimbursement in 2020 compared to 2019 across the CEDR sites. In our secondary analysis, we linked sites in the CEDR to those in NEDS to estimate nationwide reimbursement. RESULTS Total E&M reimbursement for emergency physicians in the CEDR was $1.6 billion in 2019 and $1.3 billion in 2020, reflecting a 19.7% decline year over year ($308 million loss). In our secondary analysis, we estimate nationwide losses of $6.6 billion, a -19.4% decline year over year. If emergency physicians had received maximum allowable federal relief funds via CARES Act Phases 1 to 3 (2% of 2019 revenue) this would sum to $680 million (2% of the $34 billion) or 10.3% of the estimated $6.6 billion pandemic-related losses. CONCLUSIONS Our analyses provide an estimate of the scale of economic impacts of the COVID-19 pandemic. These findings warrant consideration for policymaker relief and future redesign of emergency care financing. Ultimately, the COVID-19 pandemic likely expanded known cracks in the financing of health care into steep fault lines.
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Affiliation(s)
- Arjun K Venkatesh
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Centers for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Alexander T Janke
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy/Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Ryan Koski-Vacirca
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Craig Rothenberg
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Vivek Parwani
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Laura G Burke
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Shu-Xia Li
- Centers for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut, USA
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14
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Bodini L, Bonetto C, Maccagnani A, Bonora A, Polati E, Ricci G, Paolillo C, Amaddeo F, Lasalvia A. Changes in emergency psychiatric consultations in time of COVID-19: a retrospective observational study in the Verona Academic Hospital over the two pandemic years 2020-2021. BMC Emerg Med 2023; 23:18. [PMID: 36792989 PMCID: PMC9930055 DOI: 10.1186/s12873-023-00788-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 02/06/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND During the first months of the COVID-19 pandemic, local health authorities in most Italian regions prescribed a reduction of ordinary outpatient and community mental health care. The aim of this study was to assess the impact of the COVID-19 pandemic on access to the emergency departments (ED) for psychiatric consultation in the pandemic years 2020 and 2021 compared to 2019. METHODS This is a retrospective study conducted by using routinely collected administrative data of the two EDs of the Verona Academic Hospital Trust (Verona, Italy). All ED psychiatry consultations registered from 01.01.2020 to 31.12.2021 were compared with those registered in the pre-pandemic year (01.01.2019 to 31.12.2019). The association between each recorded characteristic and the year considered was estimated by chi-square or Fisher's exact test. RESULTS A significant reduction was observed between 2020 and 2019 (-23.3%) and between 2021 and 2019 (-16.3%). This reduction was most evident in the lockdown period of 2020 (-40.3%) and in the phase corresponding to the second and third pandemic waves (-36.1%). In 2021, young adults and people with diagnosis of psychosis showed an increase in requests for psychiatric consultation. CONCLUSIONS Fear of contagion may have been an important factor in the overall reduction in psychiatric consultations. However, psychiatric consultations for people with psychosis and for young adults increased. This finding underlines the need for mental health services to implement alternative outreach strategies aimed to support, in times of crisis, these vulnerable segments of the population.
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Affiliation(s)
- Luca Bodini
- grid.5611.30000 0004 1763 1124Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Chiara Bonetto
- grid.5611.30000 0004 1763 1124Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Antonio Maccagnani
- grid.411475.20000 0004 1756 948XUOC Pronto Soccorso, Policlinico “G.B. Rossi”, DAI Emergenza e Terapie Intensive, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Antonio Bonora
- grid.411475.20000 0004 1756 948XUOC Pronto Soccorso, Policlinico “G.B. Rossi”, DAI Emergenza e Terapie Intensive, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Enrico Polati
- grid.411475.20000 0004 1756 948XDepartment of Anaesthesia and Intensive Care B, University of Verona, DAI Emergenza e Terapie Intensive, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Giorgio Ricci
- grid.411475.20000 0004 1756 948XUOC Pronto Soccorso, Ospedale Civile Maggiore, DAI Emergenza e Terapie Intensive, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Ciro Paolillo
- grid.411475.20000 0004 1756 948XUOC Pronto Soccorso, Ospedale Civile Maggiore, DAI Emergenza e Terapie Intensive, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Francesco Amaddeo
- grid.5611.30000 0004 1763 1124Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy ,grid.411475.20000 0004 1756 948XUOC Psicosomatica e Psicologia Medica, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Antonio Lasalvia
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy. .,UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy.
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15
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McAlister FA, Hsu Z, Dong Y, Tsuyuki RT, van Walraven C, Bakal JA. Frequency and Type of Outpatient Visits for Patients With Cardiovascular Ambulatory-Care Sensitive Conditions During the COVID-19 Pandemic and Subsequent Outcomes: A Retrospective Cohort Study. J Am Heart Assoc 2023; 12:e027922. [PMID: 36734338 PMCID: PMC9973663 DOI: 10.1161/jaha.122.027922] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background Because the impact of changes in how outpatient care was delivered during the COVID-19 pandemic is uncertain, we designed this study to examine the frequency and type of outpatient visits between March 1, 2019 to February 29, 2020 (prepandemic) and from March 1, 2020 to February 28, 2021 (pandemic) and specifically compared outcomes after virtual versus in-person outpatient visits during the pandemic. Methods and Results Population-based retrospective cohort study of all 3.8 million adults in Alberta, Canada. We examined all physician visits and 30- and 90-day outcomes, with a focus on those adults with the cardiovascular ambulatory-care sensitive conditions heart failure, hypertension, and diabetes. Our primary outcome was emergency department visit or hospitalization, evaluated using survival analysis accounting for competing risk of death. Although in-person outpatient visits decreased by 38.9% in the year after March 1, 2020 (10 142 184 versus 16 592 599 in the prior year), the introduction of virtual visits (7 152 147; 41.4% of total) meant that total outpatient visits increased by 4.1% in the first year of the pandemic for Albertan adults. Outpatient visit frequency (albeit 41.4% virtual, 58.6% in-person) and prescribing patterns were stable in the first year after pandemic onset for patients with the cardiovascular ambulatory-care sensitive conditions we examined, but laboratory test frequency declined by 20% (serum creatinine) to 47% (glycosylated hemoglobin). In the first year of the pandemic, virtual outpatient visits were associated with fewer subsequent emergency department visits or hospitalizations (compared with in-person visits) for patients with heart failure (adjusted hazard ratio [aHR], 0.90 [95% CI, 0.85-0.96] at 30 days and 0.96 [95% CI, 0.92-1.00] at 90 days), hypertension (aHR, 0.88 [95% CI, 0.85-0.91] and 0.93 [95% CI, 0.91-0.95] at 30 and 90 days), or diabetes (aHR, 0.90 [95% CI, 0.87-0.93] and 0.93 [95% CI, 0.91-0.95] at 30 and 90 days). Conclusions The adoption and rapid uptake of virtual outpatient care during the COVID-19 pandemic did not negatively impact frequency of follow-up, prescribing, or short-term outcomes, and could have potentially positively impacted some of these for adults with heart failure, diabetes, or hypertension in a setting where there was an active reimbursement policy for virtual visits. Given declines in laboratory monitoring and screening activities, further research is needed to evaluate whether long-term outcomes will differ.
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Affiliation(s)
- Finlay A. McAlister
- Division of General Internal Medicine, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonAlbertaCanada,Alberta Strategy for Patient Oriented Research Support UnitEdmontonAlbertaCanada
| | - Zoe Hsu
- Alberta Strategy for Patient Oriented Research Support UnitEdmontonAlbertaCanada
| | - Yuan Dong
- Alberta Strategy for Patient Oriented Research Support UnitEdmontonAlbertaCanada
| | - Ross T. Tsuyuki
- Departments of Pharmacology, Medicine, and EPICORE Centre, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonAlbertaCanada
| | - Carl van Walraven
- Division of General Internal MedicineOttawa Hospital and the Ottawa Health Research InstituteOttawaOntarioCanada
| | - Jeffrey A. Bakal
- Alberta Strategy for Patient Oriented Research Support UnitEdmontonAlbertaCanada,Provincial Research Data Services, Alberta Health ServicesEdmontonAlbertaCanada
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Choi NG, DiNitto DM, Marti CN. Older Adults' Frequency of Going Outside during the COVID-19 Pandemic: Associations with Physical Distancing, Health Status, and Fall Risk Factors. J Appl Gerontol 2023; 42:324-335. [PMID: 36250259 PMCID: PMC9574528 DOI: 10.1177/07334648221134178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/31/2022] [Accepted: 10/04/2022] [Indexed: 02/03/2023] Open
Abstract
Research shows significant health benefits of going outside in late life. Using the 2019 and 2020 National Health and Aging Trend Study and its 2020 COVID-19 supplemental survey (N = 3,857, age 70+), we examined changes in the past-month frequency of going outside one's home/building during the COVID-19 pandemic in 2020 compared to the same time in 2019. We found that 57.0% reported no change in the frequency of going outside, 32.0% went out less frequently, and 11.0% went out more frequently. Logistic regression models showed that decreased frequency was associated with higher frequency of going outside in 2019, avoidance of contact with those outside their household (AOR = 1.51, 95% CI = 1.10, 2.06), dementia diagnosis, mobility device use, self-rated health (AOR = .85, 95% CI = .75-.97), and being 90+ years of age, female, non-Hispanic Black or Hispanic, divorced/separated. Older adults are likely to benefit from going outside more often when they can safely do so.
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Affiliation(s)
- Namkee G. Choi
- The University of Texas, Steve Hicks School of Social Work, Austin, TX 78712, USA
| | - Diana M. DiNitto
- The University of Texas, Steve Hicks School of Social Work, Austin, TX 78712, USA
| | - C. Nathan Marti
- The University of Texas, Steve Hicks School of Social Work, Austin, TX 78712, USA
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Collateral Effect of the Coronavirus Disease 2019 Pandemic on Emergency Department Visits in Korea. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:medicina59010090. [PMID: 36676714 PMCID: PMC9862451 DOI: 10.3390/medicina59010090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/26/2022] [Accepted: 12/26/2022] [Indexed: 01/03/2023]
Abstract
Background and Objectives: The ongoing coronavirus disease 2019 (COVID-19) pandemic represents a global public health crisis that has had a serious impact on emergency department (ED) utilization trends. The aim of this study was to investigate the collateral effects of the COVID-19 pandemic on ED utilization trends by patients with mild and severe conditions as well as on 7-day fatality rates. Materials and Methods: We analyzed entries in the Korean National Health Insurance claims database between 1 January 2018 and 31 December 2020. Six target patient groups were identified using the main diagnosis codes in the 10th revision of the International Classification of Diseases. Numbers of patients visiting the ED, their age, regional differences, 7-day fatality rate, and rate of emergency procedures were compared between 2018 and 2019 as the control period and 2020, when the COVID-19 pandemic was in full force. Results: During the 2020 COVID-19 pandemic, the number of patients who visited the ED with low-acuity diseases and severe acute respiratory infection diseases sharply decreased to −46.22% and −56.05%, respectively. However, the 7-day fatality rate after ED visits for low-acuity diseases and severe acute respiratory infection diseases increased to 0.04% (p < 0.01), and 1.65% (p < 0.01), respectively, in 2020 compared to that in the control period. Conclusions: During the 2020 COVID-19 pandemic, ED utilization impacted and 7-day fatality rate after ED visit increased. Health authorities and health care providers must strive to ensure prompt delivery of optimal care in EDs for patients with severe or serious symptoms and time-dependent diseases, even during the ongoing COVID-19 or potential future pandemics.
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McAlister FA, Parikh H, Lee DS, Wijeysundera HC. Health Care Implications of the COVID-19 Pandemic for the Cardiovascular Practitioner. Can J Cardiol 2022:S0828-282X(22)01051-0. [PMID: 36481398 PMCID: PMC9721374 DOI: 10.1016/j.cjca.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
There has been substantial excess morbidity and mortality during the COVID-19 pandemic, not all of which was directly attributable to SARS-CoV-2 infection, and many non-COVID-19 deaths were cardiovascular. The indirect effects of the pandemic have been profound, resulting in a substantial increase in the burden of cardiovascular disease and cardiovascular risk factors, both in individuals who survived SARS-CoV-2 infection and in people never infected. In this report, we review the direct effect of SARS-CoV-2 infection on cardiovascular and cardiometabolic disease burden in COVID-19 survivors as well as the indirect effects of the COVID-19 pandemic on the cardiovascular health of people who were never infected with SARS-CoV-2. We also examine the pandemic effects on health care systems and particularly the care deficits caused (or exacerbated) by health care delayed or foregone during the COVID-19 pandemic. We review the consequences of: (1) deferred/delayed acute care for urgent conditions; (2) the shift to virtual provision of outpatient care; (3) shortages of drugs and devices, and reduced access to: (4) diagnostic testing, (5) cardiac rehabilitation, and (6) homecare services. We discuss the broader implications of the COVID-19 pandemic for cardiovascular health and cardiovascular practitioners as we move forward into the next phase of the pandemic.
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Affiliation(s)
- Finlay A. McAlister
- The Division of General Internal Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada,The Alberta Strategy for Patient Oriented Research Support Unit, Edmonton, Alberta, Canada,Corresponding author: Dr Finlay A. McAlister, 5-134C Clinical Sciences Building, University of Alberta, 11350 83 Avenue, Edmonton, Alberta T6G 2G3, Canada. Tel.: +1-780-492-9824; fax: +1-780-492-7277
| | - Harsh Parikh
- Peter Munk Cardiac Center, Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ontario, Canada
| | - Douglas S. Lee
- Peter Munk Cardiac Center, Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ontario, Canada,ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Harindra C. Wijeysundera
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Schulich Heart Program, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
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19
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Muacevic A, Adler JR, Alghamdi AA, Alghazzawi N, Bakhsh A, Alharbi T. The Effect of COVID-19 Lockdown on Cerebrovascular Accidents, Acute Coronary Syndrome, and Diabetic Ketoacidosis Visits the Emergency Department: A Retrospective Study. Cureus 2022; 14:e33154. [PMID: 36601185 PMCID: PMC9803928 DOI: 10.7759/cureus.33154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2022] [Indexed: 01/02/2023] Open
Abstract
Objective This study aims to assess the effect of the COVID-19 lockdown on acute coronary syndrome (ACS), cerebrovascular accident (CVA), and diabetic ketoacidosis (DKA) visits the emergency department (ED). Methods We compared two groups of patients attending King Abdulaziz University Hospital (KAUH) ED diagnosed with one of the following ACS, CVA, or DKA; patients presenting from 21 December 2019 to 23 March 2020 and patients presenting from 23 March 2020 to 21 June 2020, representing COVID-19 pre-lockdown and during-lockdown period, respectively. The variables we analyzed were age, nationality (Saudi/non-Saudi), and gender. Results Our total sample size was 285 patient visits, ACS (n=130), CVA (n=98), and DKA (n=57). Results showed a statistically significant relationship between the number of patients with ACS and the period of visitation to ED (45.24% reduction, p-value <0.001), while CVA (18.5% reduction, p-value 0.312) and DKA (16% reduction, p-value 0.508) showed no statistically significant relationship. Conclusion A lockdown may be necessary to control a pandemic. However, it may carry potential collateral damage, such as a decrease and delay in the presentation of life-threatening conditions, which may lead to worsening outcomes. A clinical presentation of these conditions should warrant comprehensive evaluation by healthcare workers regardless of an ongoing pandemic while implementing infection control guidelines.
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Cunha GSPD, Cerci RJ, Silvestre OM, Cavalcanti AM, Nadruz W, Fernandes-Silva MM. Sex- and Age-Related Impact of the COVID-19 Pandemic on Emergency Department Visits for Chest Pain in Curitiba, Brazil. J Emerg Med 2022; 63:656-660. [PMID: 36243615 PMCID: PMC9376340 DOI: 10.1016/j.jemermed.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/06/2022] [Accepted: 08/04/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Women have higher mortality from acute coronary syndrome (ACS) compared with men. Women may hesitate to search for emergency care when experiencing chest pain, which delays treatment. OBJECTIVE Our aim was to evaluate the changes in emergency visits for chest pain according to sex and age during the COVID-19 pandemic period compared with previous years. METHODS We collected data on chest pain visits (International Classification of Diseases, Tenth Revision, Clinical Modification codes I20 [unstable angina], I21 [myocardial infarction], and R07.1-4 [chest pain]) from all public emergency departments (EDs) in Curitiba, Brazil. We compared the weekly rates of visits per 100,000 habitants on the epidemiologic weeks 11-52 of 2020 (COVID-19 pandemic period) with the average rates of the same weeks of 2018 and 2019 using Poisson regression. RESULTS From 2018 to 2020, 37,448 individuals presented to the ED for chest pain, of whom 8493 presented during the COVID-19 pandemic period. Compared with previous years, we observed a 23% reduction in chest pain visits (10.1 vs. 13.0 visits per 100,000 habitants/week; p < 0.001), but this reduction was greater in women than in men (30% vs. 15%; p < 0.001). This reduction was associated with age among women (27%, 31%, and 36% for < 50 years, between 50 and 69 years and > 70 years, respectively, p for age-related trend = 0.041), but not among men. CONCLUSIONS In this population-level study of Curitiba, Brazil, the reduction in ED visits during the COVID-19 pandemic was greater in women than in men, particularly among those > 70 years of age, suggesting that the sex- and age-related disparities in health care delivery for ACS may have worsened during the COVID-19 pandemic.
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Affiliation(s)
| | | | | | | | - Wilson Nadruz
- Internal Medicine Department, University of Campinas, Campinas, São Paulo, Brazil
| | - Miguel Morita Fernandes-Silva
- Internal Medicine Department, Federal University of Paraná, Curitiba, Paraná, Brazil; Quanta Diagnóstico por Imagem, Curitiba, Paraná, Brazil
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21
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Sanmarchi F, Esposito F, Adorno E, De Dominicis F, Fantini MP, Golinelli D. The impact of the SARS-CoV-2 pandemic on cause-specific mortality patterns: a systematic literature review. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2022; 31:1-19. [PMID: 36188447 PMCID: PMC9510758 DOI: 10.1007/s10389-022-01755-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/04/2022] [Indexed: 11/25/2022]
Abstract
Background Understanding the effects of the COVID-19 pandemic on cause-specific mortality should be a priority, as this metric allows for a detailed analysis of the true burden of the pandemic. The aim of this systematic literature review is to estimate the impact of the pandemic on different causes of death, providing a quantitative and qualitative analysis of the phenomenon. Methods We searched MEDLINE, Scopus, and ProQuest for studies that reported cause-specific mortality during the COVID-19 pandemic, extracting relevant data. Results A total of 2413 articles were retrieved, and after screening 22 were selected for data extraction. Cause-specific mortality results were reported using different units of measurement. The most frequently analyzed cause of death was cardiovascular diseases (n = 16), followed by cancer (n = 14) and diabetes (n = 11). We reported heterogeneous patterns of cause-specific mortality, except for suicide and road accident. Conclusions Evidence on non-COVID-19 cause-specific deaths is not exhaustive. Reliable scientific evidence is needed by policymakers to make the best decisions in an unprecedented and extremely uncertain historical period. We advocate for the urgent need to find an international consensus to define reliable methodological approaches to establish the true burden of the COVID-19 pandemic on non-COVID-19 mortality. Supplementary Information The online version contains supplementary material available at 10.1007/s10389-022-01755-7.
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Affiliation(s)
- Francesco Sanmarchi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum—Università di Bologna, Via San Giacomo 12, 40126 Bologna, Italy
| | - Francesco Esposito
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum—Università di Bologna, Via San Giacomo 12, 40126 Bologna, Italy
| | - Emanuele Adorno
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum—Università di Bologna, Via San Giacomo 12, 40126 Bologna, Italy
| | - Francesco De Dominicis
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum—Università di Bologna, Via San Giacomo 12, 40126 Bologna, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum—Università di Bologna, Via San Giacomo 12, 40126 Bologna, Italy
| | - Davide Golinelli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum—Università di Bologna, Via San Giacomo 12, 40126 Bologna, Italy
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22
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Liu Q, Lin B, Zhu C, Hu J. Emergency hospitalization caused by non-COVID-19 respiratory diseases before and during the COVID-19 pandemic: A retrospective observational cohort study. Front Med (Lausanne) 2022; 9:929353. [PMID: 35991670 PMCID: PMC9385983 DOI: 10.3389/fmed.2022.929353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/14/2022] [Indexed: 11/25/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic as well as the subsequent prevention and control measures is like a quasi-experiment intervention that might have changed the features of emergency hospitalizations. Mortality is high in patient hospitalization due to emergency respiratory diseases (ERD). Therefore, we compared the characteristics of these patients before and during the pandemic. Exploring this issue might contribute to decision-making of emergency management when most of the resources and attention has been devoted to combat COVID-19. Methods This study was a retrospective observational cohort study. All emergency hospitalizations due to ERD from January 1, 2019 to December 31, 2020 in a tertiary hospital in China were included. Data including patients’ age, sex, and clinical outcomes were extracted. Air quality was collected from the official online platform. Clinical characteristics were compared and odds ratios were calculated. Results The ERD hospitalization rate was lower in 2020 than in 2019 (6.4 vs. 4.3%, χ2 = 55.449, P = 0.000) with a 50.65% reduction; however, the patients were older in 2020 than in 2019 (P = 0.000) with a higher proportion of admission to the intensive care unit (ICU) (46 vs. 33.5%, χ2 = 20.423, P = 0.000) and a longer ICU stay (P = 0.000). The overall intubation rate, hospital mortality, and rate of discharge due to ineffective treatment in 2020 were higher than those in 2019 (15.6 vs. 8%, χ2 = 18.578, P = 0.000; 4.2 vs. 1.1%, χ2 = 4.122, P = 0.000; 5.5 vs. 2.4%, χ2 = 8.93, P = 0.000, respectively). The logistic regression analysis indicated hospitalizations due to ERD were mainly associated with PM2.5 and sulfur dioxide on the day, and on the 4th and 5th days before admission (P = 0.034 and 0.020, 0.021 and 0.000, 0.028, and 0.027, respectively) in 2019. However, in 2020, the relationship between parameters of air quality and hospitalization changed. Conclusion The COVID-19 pandemic has changed the characteristics of emergency hospitalization due to ERD with a larger proportion of severe patients and poorer prognosis. The effect of air quality on emergencies were weakened. During the COVID-19 pandemic, it is necessary to pay more attention to the non-COVID-19 emergency patients.
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Affiliation(s)
- Qi Liu
- Department of Emergency Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Translational Medicine Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Qi Liu,
| | - Bingcao Lin
- Department of Emergency Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Translational Medicine Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Changju Zhu
- Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Medical Key Laboratory of Emergency and Trauma Research, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianping Hu
- Department of Clinical Evaluation, Henan Medical Association, Zhengzhou, China
- Jianping Hu,
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23
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Milovančev A, Miljković T, Petrović M, Kovačević M, Ilić A, Bjelobrk M, Lozanov-Crvenković Z, Milosavljević AS, Tadić S, Bulatović T. Impact of the COVID-19 Pandemic on Cardiology Emergency Department Visits. Int Heart J 2022; 63:749-754. [PMID: 35831145 DOI: 10.1536/ihj.21-750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In 2020, decreased emergency department (ED) visits and hospitalization rates during the COVID-19 outbreak were reported. There is no data about cardiovascular emergencies and mortality for the whole COVID-19 year.This study aimed to compare the rates of cardiology ED visits, hospital admissions, and intrahospital mortality between the pre-COVID-19 and COVID-19 years in a single high-volume center.The retrospective observational cross-sectional study analyzed data on the number of ED visits, hospital admissions by different cardiovascular diagnoses, and outcomes.A total of 11744 patients visited the cardiology ED in the pre-COVID-19 year compared with 9145 in the COVID-19 year, indicating an overall decrease of 22.1% (P = 0.02) (IR 78.76 versus 61.33; incidence rate ratios (IRR) 1.28, P = 0.00), with an observed decrease of 25.5% in the number of hospitalizations (33.1% versus 31.6%, P = 0.02). A marked decrease in hospitalizations for cardiovascular emergencies was observed for hypertensive heart disease (-72.8%, P < 0.0001), acute coronary syndrome (-17.8%, P < 0.0001), myocardial and pericardial diseases and endocarditis (-61.2%, P = 0.00), and valvular heart disease (-70.8%, P < 0.0001). In the COVID-19 year, patients had increased need for mechanical ventilatory support (7% versus 6.3%, P = 0.03) with no overall difference in intrahospital mortality (IR 2.71 versus 2.78, IRR 0.98, 95% CI 0.82-1.16, P = 0.39).Decreased ED visits and hospitalizations not just in outbreaks but through the whole COVID-19 year highlight the risk of continuous delay of needed care for emergency life-threatening cardiovascular diseases. Urgent comprehensive strategies that will address patient- and system-related factors to decrease morbidity and mortality and prevent collateral damage of the pandemic are needed.
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Affiliation(s)
- Aleksandra Milovančev
- Faculty of Medicine, University of Novi Sad.,Institute of Cardiovascular Diseases of Vojvodina
| | - Tatjana Miljković
- Faculty of Medicine, University of Novi Sad.,Institute of Cardiovascular Diseases of Vojvodina
| | - Milovan Petrović
- Faculty of Medicine, University of Novi Sad.,Institute of Cardiovascular Diseases of Vojvodina
| | - Mila Kovačević
- Faculty of Medicine, University of Novi Sad.,Institute of Cardiovascular Diseases of Vojvodina
| | - Aleksandra Ilić
- Faculty of Medicine, University of Novi Sad.,Institute of Cardiovascular Diseases of Vojvodina
| | - Marija Bjelobrk
- Faculty of Medicine, University of Novi Sad.,Institute of Cardiovascular Diseases of Vojvodina
| | | | | | - Snežana Tadić
- Faculty of Medicine, University of Novi Sad.,Institute of Cardiovascular Diseases of Vojvodina
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24
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Jones JM, Swett AD, Crowe EP, Lawrence C, Bloch EM, Lanzkron SM. Implementation of national blood conservation recommendations at an adult sickle cell center. Transfusion 2022; 62:1763-1771. [PMID: 35837727 DOI: 10.1111/trf.17007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Due to the national blood supply crisis caused by the COVID-19 pandemic, the American Society of Hematology proposed guidance to decrease blood utilization for sickle cell patients on chronic transfusion therapy (CTT). Little evidence exists to support the efficacy and safety of these blood conservation strategies. STUDY DESIGN AND METHODS Through retrospective analysis, we sought to describe outcomes following implementation of these recommendations in 58 adult sickle cell patients on chronic exchange transfusions. The strategies employed included: relaxing the goal fraction of cells remaining (FCR) to 30%-50%, utilizing depletion exchanges in select patients, and transitioning select patients to monthly simple transfusions. We compared hemoglobin S%, hemoglobin values, and other laboratory parameters, acute care visits, and red blood cell usage during the first year of the COVID-19 pandemic to the year prior using Wilcoxon signed rank test. RESULTS Of 53 patients who remained on chronic exchanges during the pandemic, use of depletion exchange increased (15%-23%) and FCR increased (34.9 [SD 4.7] vs. 37.6 [SD 4.5], p < .05). These changes resulted in 854 units conserved without clinically significant changes to pre-exchange laboratory parameters, including hemoglobin S%, or number of acute care presentations. In contrast, five patients who transitioned to predominantly simple transfusions, experienced difficulty maintaining hemoglobin S% less than 30 and worsening anemia. DISCUSSION Our data suggest that in a blood shortage crisis, optimizing the exchange procedure itself may be the safest means of conserving blood in a population of adult patients with sickle cell disease.
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Affiliation(s)
- Jennifer M Jones
- Department of Hematology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ariel D Swett
- Department of Hematology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Elizabeth P Crowe
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Courtney Lawrence
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland, USA.,Division of Pediatric Hematology, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Evan M Bloch
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Sophie M Lanzkron
- Department of Hematology, Johns Hopkins Hospital, Baltimore, Maryland, USA
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25
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Impact of COVID-19 by Pandemic Wave among Patients with Gastroenterology Symptoms in the Emergency Departments at a Medical Center in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127516. [PMID: 35742765 PMCID: PMC9223759 DOI: 10.3390/ijerph19127516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/09/2022] [Accepted: 06/17/2022] [Indexed: 11/17/2022]
Abstract
The COVID-19 pandemic has affected emergency department (ED) usage. This study examines changes in the number of ED visits for gastrointestinal (GI) bleeding and nonemergency GI conditions, such as acute gastroenteritis (AGE) and constipation, before the pandemic and at the peak and slack periods of the pandemic in Taiwan. This retrospective observational study was conducted at a referral medical center in northern Taiwan. We recorded the number of weekly ED visits for GI bleeding, AGE, and constipation from 2019 to 2021. We then compared the baseline period (calendar weeks 4–18 and 21–31, 2019) with two peak pandemic periods (period 1, calendar weeks 4–18, 2020; period 2, calendar weeks 21–31, 2021) and their corresponding slack periods. The decline in the number of ED visits during the two peak pandemic periods for GI bleeding (−18.4% and −30.2%) were not as substantial as for AGE (−64.1% and −76.7%) or for constipation (−44.4% and −63.6%), but GI bleeding cases were still significantly lower in number relative to the baseline. During the slack period, the number of ED visits for all three diagnoses rebounded but did not exceed the baseline. Our study revealed that there was a significant decline of GI complaint during the pandemic. This phenomenon was more prominent in nonemergency complaints (AGE and constipation) and less prominent in serious complaints (GI bleeding).
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26
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Park B, Bae W, Kim HJ, Lim JY, Oh SH, Youn CS, Kim HJ, Park KN, Song H. Impact of COVID-19 pandemic on patients with cardio/cerebrovascular disease who visit the emergency department. Am J Emerg Med 2022; 58:100-105. [PMID: 35660366 PMCID: PMC9150904 DOI: 10.1016/j.ajem.2022.05.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/23/2022] [Accepted: 05/26/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction The coronavirus disease 2019 (COVID-19) pandemic situation is a state that has had a great impact on the medical system and society. To respond to the pandemic situation, various methods, such as a pre-triage system, are being implemented in the emergency medical field. However, there are insufficient studies on the effects of this pandemic situation on patients visiting the emergency department (ED), especially those with cardio/cerebrovascular diseases (CVD)1 classified as time-dependent emergencies. Methods We performed a retrospective analysis of a cohort of patients from April 2020 to December 2020 (April 2020 was when the pre-triage system was established) compared to a parallel comparison patient cohort from 2019. The primary outcome was in-hospital mortality. CVD was defined by the patient's final diagnosis. Results During the same period, the number of patients who had visited the ED after COVID-19 had decreased to 79.1% of the number of patients who had visited the ED before COVID-19. The overall patient mortality and the mortality in the patients cardiovascular disease had both increased, while the mortality from cerebrovascular disease did not increase. Meanwhile, the ED length of stay had increased in all patients but did not increase in the patients with cardiovascular disease. Conclusion As with prior studies conducted in other regions, in our study, the total number of ED visits were decreased compared to before COVID-19. The overall mortality had increased, particularly in the patients with cardiovascular disease.
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Affiliation(s)
- Beomjin Park
- Department of Emergency Medicine, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Woori Bae
- Department of Emergency Medicine, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Hyo Joon Kim
- Department of Emergency Medicine, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Jee Yong Lim
- Department of Emergency Medicine, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Sang Hoon Oh
- Department of Emergency Medicine, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Chun Song Youn
- Department of Emergency Medicine, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Han Joon Kim
- Department of Emergency Medicine, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Kyu Nam Park
- Department of Emergency Medicine, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Hwan Song
- Department of Emergency Medicine, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; Department of Emergency Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
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27
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Cash RE, Kaimal AJ, Clapp MA, Samuels-Kalow ME, Camargo CA. Change in emergency medical services-attended out-of-hospital deliveries during COVID-19 in the United States. PREHOSP EMERG CARE 2022; 27:303-309. [PMID: 35510878 DOI: 10.1080/10903127.2022.2074179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: The COVID-19 pandemic disrupted access to routine in-person prenatal care, potentially leading to higher risk of out-of-hospital deliveries. Unplanned out-of-hospital deliveries pose a substantial risk of morbidity and mortality for pregnant patients and newborns. Our objective was to determine the change in rate of emergency medical services (EMS)-attended out-of-hospital deliveries during the COVID-19 pandemic. We hypothesized that COVID-19-related stay-at-home orders were associated with a higher rate of out-of-hospital deliveries during the initial wave of COVID-19.Methods: We conducted an interrupted time series analysis using the 2019 and 2020 National EMS Information System datasets. We included 9-1-1 scene activations for patients 12-50 years old with out-of-hospital deliveries who were treated and transported by EMS. We calculated the weekly rate of deliveries per 100,000 EMS emergency activations each year overall, and for each census division. The interruption modeled was the enactment of stay-at-home orders, with March 25-31 selected as when most orders had been enacted. We fit ordinary least squares regression models with Newey-West standard errors to adjust for autocorrelation, testing for a change in level and slope overall and by census division.Results: A total of 10,778 out-of-hospital deliveries were included, 58% (n = 6,254) in 2020. The mean weekly rate of out-of-hospital deliveries in 2019 was 29.4 per 100,000 activations (95% CI: 28.4 to 30.4) versus 33.0 (95% CI: 31.8 to 34.1) in 2020. There was an immediate increase of 6.3 deliveries per 100,000 activations (95% CI: 3.3 to 9.3) after the week of March 25-31, with a subsequent decrease of 0.3 deliveries per 100,000 per week after (95% CI: -0.4 to -0.2). There were also statistically significant immediate increases in out-of-hospital deliveries after March 25-31 in the New England, East North Central, West South Central, and Mountain divisions.Conclusion: EMS-attended out-of-hospital deliveries remained rare during the COVID-19 pandemic, but there was an immediate increase during the initial wave of the pandemic with evidence of geographic variation. Large-scale disruptions in the health care system may result in increases in uncommon patient presentations to EMS.
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Affiliation(s)
- Rebecca E Cash
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Anjali J Kaimal
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Mark A Clapp
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Margaret E Samuels-Kalow
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Grande M, Bjørnsen LP, Næss-Pleym LE, Laugsand LE, Grenne B. Observational study on chest pain during the Covid-19 pandemic: changes and characteristics of visits to a Norwegian emergency department during the lockdown. BMC Emerg Med 2022; 22:57. [PMID: 35366802 PMCID: PMC8976421 DOI: 10.1186/s12873-022-00612-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 03/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background Following the spread of the Covid-19 pandemic in 2020, reports emerged on decreasing emergency department (ED) visits in many countries. Patients experiencing chest pain was no exception. The aim of the current study was to describe how the Covid-19 pandemic and the subsequential lockdown impacted the chest pain population in a Norwegian ED. Methods All patients presenting to the ED with chest pain during the study period were included. Data were collected retrospectively from the time period January 6th to August 30th, 2020, and compared to the corresponding period in 2019, assessing variations in the number of ED visits, severity, gender, and age. Results Fewer patients with chest pain were seen in the ED following the national lockdown in Norway, compared to the corresponding 2019 period (week 13: 38% fewer; weeks 11–27: 16% fewer). By week 28, the rate normalized compared to 2019 levels. There was a relative increase in lower acuity patients among these patients, while fewer moderate acuity patients were seen. During the initial period following lockdown, the median age was lower compared to the corresponding 2019 period (58 years (IQR 25) vs 62 years (IQR 24), respectively). Admissions due to acute coronary syndromes (ACS) remained proportionally stable. Conclusions Succeeding the Covid-19 outbreak and the subsequent national lockdown in Norway, fewer chest pain patients presented to the ED. Paradoxically, the patients seemed to be less severely ill and were on average younger compared to 2019 data. However, the proportion of patients admitted with ACS was stable during this period. This could imply that some patients may have failed to seek medical advice despite experiencing a myocardial infarction.
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Dupraz J, Le Pogam MA, Peytremann-Bridevaux I. Early impact of the COVID-19 pandemic on in-person outpatient care utilisation: a rapid review. BMJ Open 2022; 12:e056086. [PMID: 35241471 PMCID: PMC8895419 DOI: 10.1136/bmjopen-2021-056086] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To quantitatively assess the early impact of the COVID-19 pandemic on in-person outpatient care utilisation worldwide, as well as across categories of services, types of care and medical specialties. DESIGN Rapid review. METHOD A search of MEDLINE and Embase was conducted to identify studies published from 1 January 2020 to 12 February 2021, which quantitatively reported the impact of the COVID-19 pandemic on the amount of outpatient care services delivered (in-person visits, diagnostic/screening procedures and treatments). There was no restriction on the type of medical care (emergency/primary/specialty care) or target population (adult/paediatric). All articles presenting primary data from studies reporting on outpatient care utilisation were included. Studies describing conditions requiring hospitalisation or limited to telehealth services were excluded. RESULTS A total of 517 articles reporting 1011 outpatient care utilisation measures in 49 countries worldwide were eligible for inclusion. Of those, 93% focused on the first semester of 2020 (January to June). The reported results showed an almost universal decline in in-person outpatient care utilisation, with a 56% overall median relative decrease. Heterogeneity across countries was high, with median decreases ranging from 10% to 91%. Diagnostic and screening procedures (-63%), as well as in-person visits (-56%), were more affected than treatments (-36%). Emergency care showed a smaller relative decline (-49%) than primary (-60%) and specialty care (-58%). CONCLUSIONS The provision of in-person outpatient care services has been strongly impacted by the COVID-19 pandemic, but heterogeneously across countries. The long-term population health consequences of the disruption of outpatient care service delivery remain currently unknown and need to be studied. PROSPERO REGISTRATION NUMBER CRD42021237366.
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Affiliation(s)
- Julien Dupraz
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Marie-Annick Le Pogam
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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Khalid I, Saeedi M, Alzarnougi EM, Alraddadi A, Afifi A, Imran M, Alshukairi AN, Akhtar MA, Imran M, Khalid TJ. Too early for admission? A Telemedicine follow up comparison of mild COVID-19 patients from the Emergency Department and Clinics. Int J Health Sci (Qassim) 2022; 16:22-29. [PMID: 35024031 PMCID: PMC8721213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Mildly symptomatic COVID-19 patients may seek medical attention either in the Emergency Department (ED) or Ambulatory Clinics (AC). However, it is unclear if ED patients have different characteristics and outcomes than AC patients when discharged under telemedicine surveillance, which we explored in this study. METHODS Patients with mild or asymptomatic COVID-19 disease referred to a multidisciplinary Telemedicine clinical service (TM-CS) program in an urban tertiary-care hospital, between June 2020 and February 2021, were evaluated. Those referred from ED were labeled "ED Group" and ones from AC as "AC Group." Their characteristics, clinical features and outcomes including telemedicine parameters, subsequent ED visits, hospital admission, oxygen requirements, intensive care unit (ICU) admission, and mortality were compared. RESULTS Out of 1132 confirmed non-admitted COVID-19 patients, 526 with mild (89%) or asymptomatic (11%) disease were enrolled in TM-CS. Majority of these were referred from ED (n = 370; 70%) and rest (n = 156, 30%) from the AC. Patients in the ED group compared to AC group, had higher BMI (28.9 vs. 27.5), higher Charlson Comorbidity Index (1.4 vs. 0.9), and higher incidence of comorbidities (50% vs. 22%), P ≤ 0.01. However, there were no differences in the ED and AC groups in subsequent ED visits (26% vs. 24%), hospital admission (18% vs. 15%), oxygen requirements (5% vs. 4%), ICU admission (1% vs. 2%), and mortality (0.3% vs. 0.6%), respectively (P > 0.40). CONCLUSION Significant number of mild COVID-19 patients head to the ED for initial assistance but have similar outcomes to AC patients. TM-CS could be a safe alternative for follow-up monitoring of these patients.
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Affiliation(s)
- Imran Khalid
- John D Dingell VA Medical Center, Detroit, MI, USA, King Faisal Specialist Hospital and Research Center, Jeddah, KSA,Address for correspondence: Dr. Imran Khalid, King Faisal Specialist Hospital and Research Center, Jeddah, 21499, Saudi Arabia. E-mail:
| | - Mohammad Saeedi
- King Faisal Specialist Hospital and Research Center, Jeddah, KSA
| | | | | | - Afnan Afifi
- King Faisal Specialist Hospital and Research Center, Jeddah, KSA
| | - Maryam Imran
- Department of Medicine, Shifa College of Medicine, Islamabad, Pakistan
| | | | | | - Manahil Imran
- Department of Medicine, Shifa College of Medicine, Islamabad, Pakistan
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Oskvarek JJ, Aldeen A, Shawbell J, Venkat A, Zocchi MS, Pines JM. Opioid Prescription Reduction After Implementation of a Feedback Program in a National Emergency Department Group. Ann Emerg Med 2022; 79:420-432. [DOI: 10.1016/j.annemergmed.2021.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 02/07/2023]
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Reschen ME, Bowen J, Novak A, Giles M, Singh S, Lasserson D, O'Callaghan CA. Impact of the COVID-19 pandemic on emergency department attendances and acute medical admissions. BMC Emerg Med 2021; 21:143. [PMID: 34800973 PMCID: PMC8605447 DOI: 10.1186/s12873-021-00529-w] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 10/27/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To better understand the impact of the COVID-19 pandemic on hospital healthcare, we studied activity in the emergency department (ED) and acute medicine department of a major UK hospital. METHODS Electronic patient records for all adult patients attending ED (n = 243,667) or acute medicine (n = 82,899) during the pandemic (2020-2021) and prior year (2019) were analysed and compared. We studied parameters including severity, primary diagnoses, co-morbidity, admission rate, length of stay, bed occupancy, and mortality, with a focus on non-COVID-19 diseases. RESULTS During the first wave of the pandemic, daily ED attendance fell by 37%, medical admissions by 30% and medical bed occupancy by 27%, but all returned to normal within a year. ED attendances and medical admissions fell across all age ranges; the greatest reductions were seen for younger adults in ED attendances, but in older adults for medical admissions. Compared to non-COVID-19 pandemic admissions, COVID-19 admissions were enriched for minority ethnic groups, for dementia, obesity and diabetes, but had lower rates of malignancy. Compared to the pre-pandemic period, non-COVID-19 pandemic admissions had more hypertension, cerebrovascular disease, liver disease, and obesity. There were fewer low severity ED attendances during the pandemic and fewer medical admissions across all severity categories. There were fewer ED attendances with common non-respiratory illnesses including cardiac diagnoses, but no change in cardiac arrests. COVID-19 was the commonest diagnosis amongst medical admissions during the first wave and there were fewer diagnoses of pneumonia, myocardial infarction, heart failure, cellulitis, chronic obstructive pulmonary disease, urinary tract infection and other sepsis, but not stroke. Levels had rebounded by a year later with a trend to higher levels of stroke than before the pandemic. During the pandemic first wave, 7-day mortality was increased for ED attendances, but not for non-COVID-19 medical admissions. CONCLUSIONS Reduced ED attendances in the first wave of the pandemic suggest opportunities for reducing low severity presentations to ED in the future, but also raise the possibility of harm from delayed or missed care. Reassuringly, recent rises in attendance and admissions indicate that any deterrent effect of the pandemic on attendance is diminishing.
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Affiliation(s)
- Michael E Reschen
- Department of Acute General Medicine, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, OX3 9DU, Oxford, UK.
| | - Jordan Bowen
- Department of Acute General Medicine, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, OX3 9DU, Oxford, UK
| | - Alex Novak
- Emergency Medicine Research Oxford (EMROx), John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK
| | - Matthew Giles
- Department of Acute General Medicine, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, OX3 9DU, Oxford, UK
| | - Sudhir Singh
- Department of Acute General Medicine, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, OX3 9DU, Oxford, UK
| | - Daniel Lasserson
- Department of Acute General Medicine, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, OX3 9DU, Oxford, UK
| | - Christopher A O'Callaghan
- Nuffield Department of Medicine, NIHR Oxford Biomedical Research Centre, Old Road Campus, Oxford, OX3 7BN, UK
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Firman D, Mangkuanom AS, Iryuza N, Fahri I, Artha IMJR, Mulia E, Syukri M, Yonas E, Pranata R, Alkatiri AA. Decrease in the Number of Patients Presenting With ST-Segment Elevation Myocardial Infarction Across Catheterization Centers in Indonesia During the Coronavirus Disease 2019 Pandemic. Front Cardiovasc Med 2021; 8:676592. [PMID: 34490361 PMCID: PMC8418056 DOI: 10.3389/fcvm.2021.676592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic has become a global problem, put a heavy burden on the health care system, and resulted in many fatalities across the globe. A reduction in the number of cardiac emergencies, especially ST-segment elevation myocardial infarction (STEMI), is observed worldwide. In this study, we aimed to analyze the trends of cases and presentation of STEMI across several cardiac catheterization centers in Indonesia. Method: This retrospective study was performed by combining medical record data from five different hospitals in Indonesia. We compared data from the time period between February to June 2019 with those between February and June 2020. Patients who were diagnosed with STEMI and underwent primary percutaneous coronary intervention (PPCI) procedures were included in the study. Results: There were 41,396 emergency department visits in 2019 compared with 29,542 in 2020. The number of patients with STEMI declined significantly from 338 in 2019 to 190 in 2020. Moreover, the total number of PPCI procedures reduced from 217 in 2019 to 110 in 2020. The proportion of PPCI was not significantly reduced (64.2 vs. 57.9%). The majority of the patients were men, with a mean age of 54 years in 2019 and 55 years in 2020. We observed a significantly longer door-to-balloon time in 2020 than in 2019 (p < 0.001). We also observed a difference in the door-to-balloon time and ischemic time between the two periods. Conclusion: We observed a decline in the number of patients presenting with STEMI to our centers. However, we observed no significant decline in the percentage of PPCI performed across our centers during this pandemic.
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Affiliation(s)
- Doni Firman
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Arwin Saleh Mangkuanom
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Nanda Iryuza
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Ismir Fahri
- Department of Cardiology and Vascular Medicine, Mohammad Yunus General Hospital, Bengkulu, Indonesia
| | - I Made Junior Rina Artha
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Udayana University, Sanglah General Hospital, Denpasar, Indonesia
| | - Erwin Mulia
- Department of Cardiology and Vascular Medicine, Bumi Waras Hospital, Lampung, Indonesia
| | - Muhammad Syukri
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Andalas, DR. M. Djamil General Hospital, Padang, Indonesia
| | - Emir Yonas
- Faculty of Medicine, Universitas YARSI, Jakarta, Indonesia
| | - Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Banten, Indonesia
| | - Amir Aziz Alkatiri
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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Bhatt AS, Adler ED, Albert NM, Anyanwu A, Bhadelia N, Cooper LT, Correa A, Defilippis EM, Joyce E, Sauer AJ, Solomon SD, Vardeny O, Yancy C, Lala A. Coronavirus Disease-2019 and Heart Failure: A Scientific Statement From the Heart Failure Society of America. J Card Fail 2021; 28:93-112. [PMID: 34481067 PMCID: PMC8408888 DOI: 10.1016/j.cardfail.2021.08.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Ankeet S Bhatt
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Eric D Adler
- Department of Cardiology, University of California, San Diego, California
| | - Nancy M Albert
- Nursing Institute and Heart, Vascular and Thoracic Institute; Cleveland Clinic, Cleveland, Ohio
| | - Anelechi Anyanwu
- Department of Cardiovascular Surgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nahid Bhadelia
- Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts; Center for Emerging Infectious Diseases Policy and Research (CEID), Boston University, Boston, Massachusetts
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
| | - Ashish Correa
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ersilia M Defilippis
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Emer Joyce
- Department of Cardiovascular Medicine, Mater University Hospital, and School of Medicine, University College Dublin, Ireland
| | - Andrew J Sauer
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, Kansas
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Orly Vardeny
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, and University of Minnesota, Minneapolis
| | - Clyde Yancy
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anuradha Lala
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
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Bhatia R, Sylaja PN, Srivastava MVP, Komakula S, Iype T, Parthasarathy R, Khurana D, Pardasani V, Pamidimukkala V, Kumaravelu S, Pandian J, Kushwaha S, Chowdhury D, Gupta S, Rajendran SP, Reddy R, Roy J, Sharma A, Nambiar V, Rai NK, Upadhyay AD, Parkipandla S, Singh MB, Vibha D, Vishnu VY, Rajan R, Gupta A, Pandit AK, Agarwal A, Gaikwad SB, Garg A, Joseph L, Sreedharan SE, Reddy S, Sreela K, Ramachandran D, George GB, Panicker P, Suresh MK, Gupta V, Ray S, Suri V, Ahuja C, Kajal K, Lal V, Singh RK, Oza H, Halani H, Sanivarapu S, Sahonta R, Duggal A, Dixit P, Kulkarni GB, Taallapalli AVR, Parmar M, Chalasani V, Kashyap M, Misra B, Pachipala S, Yogeesh PM, Salunkhe M, Gupta P. Clinical profile and outcome of non-COVID strokes during pandemic and the pre pandemic period: COVID-Stroke Study Group (CSSG) India. J Neurol Sci 2021; 428:117583. [PMID: 34375915 PMCID: PMC8282445 DOI: 10.1016/j.jns.2021.117583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/02/2021] [Accepted: 07/13/2021] [Indexed: 11/26/2022]
Abstract
Background As the health systems around the world struggled to meet the challenges of COVID-19 pandemic, care of many non-COVID emergencies was affected. Aims The present study examined differences in the diagnosis, evaluation and management of stroke patients during a defined period in the ongoing pandemic in 2020 when compared to a similar epoch in year 2019. Methods The COVID stroke study group (CSSG) India, included 18 stroke centres spread across the country. Data was collected prospectively between February and July 2020 and retrospectively for the same period in 2019. Details of demographics, stroke evaluation, treatment, in-hospital and three months outcomes were collected and compared between these two time points. Results A total of 2549 patients were seen in both study periods; 1237 patients (48.53%) in 2019 and 1312 (51.47%) in 2020. Although the overall number of stroke patients and rates of thrombolysis were comparable, a significant decline was observed in the month of April 2020, during the initial period of the pandemic and lockdown. Endovascular treatment reduced significantly and longer door to needle and CT to needle times were observed in 2020. Although mortality was higher in 2020, proportion of patients with good outcome were similar in both the study periods. Conclusions Although stroke admissions and rates of thrombolysis were comparable, some work flow metrics were delayed, endovascular stroke treatment rates declined and mortality was higher during the pandemic study period. Reorganization of stroke treatment pathways during the pandemic has likely improved the stroke care delivery across the globe.
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Affiliation(s)
- Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
| | - P N Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Snigdha Komakula
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Thomas Iype
- Department of Neurology, Government Medical College, Thiruvananthapuram, India
| | | | - Dheeraj Khurana
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Vijaya Pamidimukkala
- Department of Neurology, Lalitha Super Specialities Hospital Pvt. Ltd, Guntur, India
| | - S Kumaravelu
- Department of Neurology, Ramesh Hospitals, Guntur, India
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College, Ludhiana, India
| | - Suman Kushwaha
- Department of Neurology, Institute of Human Behavior and Allied Sciences (IBHAS), New Delhi, India
| | - Debashish Chowdhury
- Department of Neurology, Gobind Ballabh Pant Institute of Postgraduate Education and Research (GIPMER), New Delhi, India
| | - Salil Gupta
- Department of Neurology, Command Hospital, Bengaluru, India
| | - Srijithesh P Rajendran
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), India
| | - Rajshekar Reddy
- Department of Neurology, Max Hospital Saket, New Delhi, India
| | - Jayanta Roy
- Department of Neurology, Institute of Neurosciences, Kolkata, India
| | - Arvind Sharma
- Zydus Hospital, BJMC & Civil Hospital, Ahmedabad, India
| | - Vivek Nambiar
- Department of Neurology, Amrita Institute of Medical Sciences, Kochi, India
| | - Nirendra Kumar Rai
- Department of Neurology, All India Institute of Medical Sciences, Bhopal, India
| | - Ashish Datt Upadhyay
- Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sathish Parkipandla
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Mamta Bhushan Singh
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Deepti Vibha
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Venugopalan Y Vishnu
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Anu Gupta
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Awadh Kishore Pandit
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ayush Agarwal
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Shailesh B Gaikwad
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ajay Garg
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Leve Joseph
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sapna Erat Sreedharan
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, India
| | - Sritheja Reddy
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, India
| | - Krishna Sreela
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, India
| | - Dileep Ramachandran
- Department of Neurology, Government Medical College, Thiruvananthapuram, India
| | - Githin Benoy George
- Department of Neurology, Government Medical College, Thiruvananthapuram, India
| | - Praveen Panicker
- Department of Neurology, Government Medical College, Thiruvananthapuram, India
| | - M K Suresh
- Department of Medicine, Government Medical College, Thiruvananthapuram, India
| | - Vipul Gupta
- Department of Neurointerventional Surgery, Artemis Hospital, Gurgaon, India
| | - Sucharita Ray
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vikas Suri
- Department of Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Chirag Ahuja
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kamal Kajal
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vivek Lal
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Harsh Oza
- Department of Neurology, Bombay Hospital, Mumbai, India
| | - Hiral Halani
- Department of Neurology, Bombay Hospital, Mumbai, India
| | | | | | - Ashish Duggal
- Department of Neurology, Gobind Ballabh Pant Institute of Postgraduate Education and Research (GIPMER), New Delhi, India
| | - Prashant Dixit
- Department of Neurology, Command Hospital, Bengaluru, India
| | - Girish Baburao Kulkarni
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), India
| | - A V R Taallapalli
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), India
| | - Mamta Parmar
- Zydus Hospital, BJMC & Civil Hospital, Ahmedabad, India
| | - Vamsi Chalasani
- Department of Neurology, Amrita Institute of Medical Sciences, Kochi, India
| | - Manshi Kashyap
- Department of Neurology, All India Institute of Medical Sciences, Bhopal, India
| | - Biswamohan Misra
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sudheer Pachipala
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - P M Yogeesh
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Manish Salunkhe
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Pranjal Gupta
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Flattening the other curve: Reducing emergency department STEMI delays during the COVID-19 pandemic. Am J Emerg Med 2021; 49:367-372. [PMID: 34246966 PMCID: PMC8254397 DOI: 10.1016/j.ajem.2021.06.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 02/06/2023] Open
Abstract
Background The COVID-19 pandemic has been associated with ST-Elevation Myocardial Infarction (STEMI) reperfusion delays despite reduced emergency department (ED) volumes. However, little is known about ED contributions to these delays. We sought to measure STEMI delays and ED quality benchmarks over the course of the first two waves of the pandemic. Study This study was a multi-centre, retrospective chart review from two urban, academic medical centres. We obtained ED volumes, COVID-19 tests and COVID-19 cases from the hospital databases and ED Code STEMIs with culprit lesions from the cath lab. We measured door-to-ECG (DTE) time and ECG-to-Activation (ETA) time during the phases of the pandemic in our jurisdiction: pre-first wave (Jan-Mar 2020), first wave (Apr-June 2020), post-first wave (July-Nov 2020), and second wave (Dec 2020 to Feb 2021). We calculated median DTE and ETA times and compared them to the 2019 baseline using Wilcox rank-sum test. We calculated the percentages of DTE ≤10 min and of ETA ≤10 min and compared them to baseline using chi-square test. We also utilized Statistical Process Control (SPC) Xbar-R charts to assess for special cause variation. Results COVID-19 cases began during the pre-wave phase, but there was no change in ED volumes or STEMI quality metrics. During the first wave ED volumes fell by 40%, DTE tripled (10.0 to 29.5 min, p = 0.016), ETA doubled (8.5 to 17.0 min, p = 0.04), and percentages for both DTE ≤10 min and ETA ≤10 min fell by three-quarters (each from more than 50%, to both 12.5%, both p < 0.05). After the first wave all STEMI quality benchmarks returned to baseline and did not significantly change during the second wave. A brief period of special cause variation was noted for DTE during the first wave. Conclusions Both DTE and ETA metrics worsened during the first wave of the pandemic, revealing how it negatively impacted the triage and diagnosis of STEMI patients. But these normalized after the first wave and were unaffected by the second wave, indicating that nurses and physicians adapted to the pandemic to maintain STEMI quality of care. DTE and ETA metrics can help EDs identify delays to reperfusion during the pandemic and beyond.
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Disparities on the rebound in the emergency department in Taiwan during COVID-19 pandemic. Am J Emerg Med 2021; 53:271-273. [PMID: 33972123 PMCID: PMC8095038 DOI: 10.1016/j.ajem.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/02/2021] [Indexed: 11/26/2022] Open
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Pines JM, Zocchi MS, Black BS, Kornas R, Celedon P, Moghtaderi A, Venkat A. The Effect of the COVID-19 Pandemic on the Economics of United States Emergency Care. Ann Emerg Med 2021; 78:487-499. [PMID: 34120751 PMCID: PMC8075818 DOI: 10.1016/j.annemergmed.2021.04.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/06/2021] [Accepted: 04/19/2021] [Indexed: 02/07/2023]
Abstract
Study objective We describe how the coronavirus disease 2019 (COVID-19) pandemic affected the economics of emergency department care (ED). Methods We conducted an observational study of 136 EDs from January 2019 to September 2020, using 2020-to-2019 3-week moving ratios for ED visits, complexity, revenue, and staffing expenses. We tabulated 2020-to-2019 staffing ratios and calculated hour and full-time-equivalent changes. Results Following the COVID-19 pandemic’s onset, geriatric (age ≥65), adult (age 18 to 64), and pediatric (age <18) ED visits declined by 43%, 40%, and 73%, respectively, compared to 2019 visits and rose thereafter but remained below 2019 levels through September. Relative value units per visit rose by 8%, 9%, and 18%, respectively, compared to 2019, while ED admission rates rose by 32%. Both fell subsequently but remained above 2019 levels through September. Revenues dropped sharply early in the pandemic and rose gradually but remained below 2019 levels. In medium and large EDs, staffing and expenses were lowered with a lag, largely compensating for lower revenue at these sites, and barely at freestanding EDs. Staffing and expense reductions could not match revenue losses in smaller EDs. During the pandemic, emergency physician and advanced practice provider clinical hours and compensation fell 15% and 27%, respectively, corresponding to 174 lost physician and 193 lost advanced practice provider full-time-equivalent positions. Conclusion The COVID-19 pandemic adversely impacted the economics of ED care, with large drops in overall and, in particular, low-acuity ED visits, necessitating reductions in clinical hours. Staffing cutbacks could not match reduced revenue at small EDs with minimum emergency physician coverage requirements.
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Affiliation(s)
- Jesse M Pines
- US Acute Care Solutions, Canton, OH; Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA.
| | - Mark S Zocchi
- Department of Health Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA
| | - Bernard S Black
- Pritzker School of Law and Kellogg School of Management, Northwestern University, Evanston, IL
| | - Rebecca Kornas
- Department of Emergency Medicine, Avista Hospital, Louisville, CO
| | | | - Ali Moghtaderi
- Department of Health Policy and Management, George Washington University, Washington, DC
| | - Arvind Venkat
- US Acute Care Solutions, Canton, OH; Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA
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