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Hanson HR, Formica M, Laraque-Arena D, Zonfrillo MR, Desai P, O'Neil JO, Unni P, Johnson EL, Cobb P, Agarwal M, Beckworth K, Schroter S, Strotmeyer S, Donnelly KA, Middelberg LK, Morse AM, Dodington J, Latuska RF, Anderson B, Lawson KA, Valente M, Levas MN, Kiragu AW, Monroe K, Ruest SM, Lee LK, Charyk Stewart T, Attridge MM, Haasz M, Jafri M, McIntire A, Rogers SC, Uspal NG, Blanchard A, Hazeltine MD, Riech T, Jennissen C, Model L, Fu Q, Clukies LD, Juang D, Ruda MT, Prince JM, Chao S, Yorkgitis BK, Pomerantz WJ. A multicenter evaluation of pediatric emergency department injury visits during the COVID-19 pandemic. Inj Epidemiol 2023; 10:66. [PMID: 38093383 PMCID: PMC10717699 DOI: 10.1186/s40621-023-00476-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Injuries, the leading cause of death in children 1-17 years old, are often preventable. Injury patterns are impacted by changes in the child's environment, shifts in supervision, and caregiver stressors. The objective of this study was to evaluate the incidence and proportion of injuries, mechanisms, and severity seen in Pediatric Emergency Departments (PEDs) during the COVID-19 pandemic. METHODS This multicenter, cross-sectional study from January 2019 through December 2020 examined visits to 40 PEDs for children < 18 years old. Injury was defined by at least one International Classification of Disease-10th revision (ICD-10) code for bodily injury (S00-T78). The main study outcomes were total and proportion of PED injury-related visits compared to all visits in March through December 2020 and to the same months in 2019. Weekly injury visits as a percentage of total PED visits were calculated for all weeks between January 2019 and December 2020. RESULTS The study included 741,418 PED visits for injuries pre-COVID-19 pandemic (2019) and during the COVID-19 pandemic (2020). Overall PED visits from all causes decreased 27.4% in March to December 2020 compared to the same time frame in 2019; however, the proportion of injury-related PED visits in 2020 increased by 37.7%. In 2020, injured children were younger (median age 6.31 years vs 7.31 in 2019), more commonly White (54% vs 50%, p < 0.001), non-Hispanic (72% vs 69%, p < 0.001) and had private insurance (35% vs 32%, p < 0.001). Injury hospitalizations increased 2.2% (p < 0.001) and deaths increased 0.03% (p < 0.001) in 2020 compared to 2019. Mean injury severity score increased (2.2 to 2.4, p < 0.001) between 2019 and 2020. Injuries declined for struck by/against (- 4.9%) and overexertion (- 1.2%) mechanisms. Injuries proportionally increased for pedal cycles (2.8%), cut/pierce (1.5%), motor vehicle occupant (0.9%), other transportation (0.6%), fire/burn (0.5%) and firearms (0.3%) compared to all injuries in 2020 versus 2019. CONCLUSIONS The proportion of PED injury-related visits in March through December 2020 increased compared to the same months in 2019. Racial and payor differences were noted. Mechanisms of injury seen in the PED during 2020 changed compared to 2019, and this can inform injury prevention initiatives.
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Affiliation(s)
- Holly R Hanson
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
| | - Margaret Formica
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Danielle Laraque-Arena
- New York Academy of Medicine, New York, New York, USA
- Clinical Epidemiology and Pediatrics, Mailman School of Public Health and Vagelos College of Physicians & Surgeons, Columbia University, Syracuse, NY, USA
| | - Mark R Zonfrillo
- Department of Emergency Medicine, Hasbro Children's Hospital and Alpert Medical School of Brown University, Providence, RI, USA
- Department of Pediatrics, Hasbro Children's Hospital and Alpert Medical School of Brown University, Providence, RI, USA
| | - Puja Desai
- Department of Pediatrics, St. Louis Children's Hospital and Washington University School of Medicine, St. Louis, MO, USA
| | - Joseph O O'Neil
- Department of Pediatrics, Indiana University, Indianapolis, IN, USA
| | - Purnima Unni
- Department of Pediatric Trauma, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Estell Lenita Johnson
- Department of Epidemiology, School of Public Health, Injury Free Coalition for Kids, Columbia University, New York City, NY, USA
| | - Patricia Cobb
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Maneesha Agarwal
- Department of Pediatrics and Emergency Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Kristen Beckworth
- Center for Childhood Injury Prevention, Texas Children's Hospital, Houston, TX, USA
| | - Stephanie Schroter
- Department of Pediatric Emergency Medicine, University of California, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Stephen Strotmeyer
- Department of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- Allegheny County Health Department, Pittsburgh, PA, USA
| | - Katie A Donnelly
- Division of Emergency Medicine, Children's National Hospital, Washington, DC, USA
| | - Leah K Middelberg
- Division of Emergency Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Amber M Morse
- Division of Pediatric Emergency Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA
| | | | - Richard F Latuska
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brit Anderson
- Department of Pediatric Emergency Medicine, Norton Children's Hospital, Louisville, KY, USA
| | - Karla A Lawson
- Trauma and Injury Research Center, Dell Children's Medical Center of Central Texas, Austin, TX, USA
| | - Michael Valente
- Department of Pediatric Emergency Medicine, Children's Health Orange County, Orange, CA, USA
| | - Michael N Levas
- Department of Pediatric Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrew Waititu Kiragu
- Department of Pediatrics, University of Minnesota and Children's Minnesota, Minneapolis, MN, USA
| | - Kathy Monroe
- Division of Pediatric Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stephanie M Ruest
- Department of Emergency Medicine, Hasbro Children's Hospital and Alpert Medical School of Brown University, Providence, RI, USA
- Department of Pediatrics, Hasbro Children's Hospital and Alpert Medical School of Brown University, Providence, RI, USA
| | - Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Tanya Charyk Stewart
- Department of Paediatrics, University of Western Ontario and London Health Sciences Centre, London, ON, Canada
| | - Megan M Attridge
- Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Maya Haasz
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Mubeen Jafri
- Department of Pediatric Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Alicia McIntire
- Department of Pediatric Surgery, Randall Children's Hospital at Emanuel Legacy, Portland, OR, USA
| | - Steven C Rogers
- Department of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Hospital, Hartford, CT, USA
| | - Neil G Uspal
- Division of Emergency Medicine, University of Washington, Seattle Children's Hospital, Seattle, WA, USA
| | - Ashley Blanchard
- Department of Emergency Medicine, Columbia University Medical Center, New York City, NY, USA
| | - Max D Hazeltine
- Department of Surgery, UMass Chan Medical School, Worcester, MA, USA
| | - Teresa Riech
- Department of Pediatric Emergency Medicine, OSF Saint Francis Medical Center, Peoria, IL, USA
| | - Charles Jennissen
- Department of Pediatrics, Roy J. and Lucille A. Carter College of Medicine, University of Iowa, Iowa City, IA, USA
- Department of Emergency Medicine, Roy J. and Lucille A. Carter College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Lynn Model
- Department of Pediatric Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Quinney Fu
- Division of Emergency Medicine, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Lindsay D Clukies
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - David Juang
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Michelle T Ruda
- Department of Pediatrics, Children's Memorial Hermann Hospital, UTHealth Houston, Houston, TX, USA
| | - Jose M Prince
- Department of Pediatric Surgery, Northwell Health, New Hyde Park, NY, USA
| | - Stephanie Chao
- Division of Pediatric Surgery, Stanford School of Medicine, Palo Alto, CA, USA
| | - Brian K Yorkgitis
- Department of Surgery, University of FL College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Wendy J Pomerantz
- Division of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Gurbuz H, Basol G, Altintas MM, Kuru B. The impact of the first wave of the COVID-19 pandemic on hospital admissions and treatment management of ectopic pregnancy. Turk J Emerg Med 2023; 23:238-243. [PMID: 38024190 PMCID: PMC10664196 DOI: 10.4103/tjem.tjem_37_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/28/2023] [Accepted: 04/23/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVES We aimed to evaluate the clinical features and treatment strategies applied to the patients with ectopic pregnancy admitted to our tertiary care center before and during the pandemic. METHODS Women aged 18-45 years, who were admitted to the hospital with a diagnosis of ectopic pregnancy in the pre- and postpandemic periods, were included in this case-control study. RESULTS A total of 173 patients, 116 patients before the pandemic and 57 patients during the pandemic, were included in the study. The rate of admissions from the emergency department was higher during the pandemic than before the pandemic (P = 0.003). The rupture was detected significantly higher during the outbreak (13/116 [11.2%]) than before the pandemic (16/57 [28.1%]) (P = 0.009). While conservative treatment was applied more frequently in the prepandemic period, it was observed that patients were treated surgically more frequently during the pandemic period (P = 0.003). While laparoscopic surgery was preferred before the pandemic, laparotomy was applied to all patients during the pandemic (P < 0.001). CONCLUSIONS In the first wave of the outbreak, there were delays in the diagnosis of ectopic pregnancies, and these patients presented with ruptures more frequently than before the pandemic. Furthermore, surgical treatment methods were used more than conservative therapies during the outbreak.
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Affiliation(s)
- Hande Gurbuz
- Department of Anesthesiology and Reanimation, Bursa City Hospital, University of Health Sciences, Bursa, Turkey
| | - Gulfem Basol
- Department of Obstetrics and Gynecology, Kartal Dr. Lutfi Kirdar City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Mustafa Altintas
- Department of General Surgery, Kartal Dr. Lutfi Kirdar City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Betul Kuru
- Department of Obstetrics and Gynecology, Kartal Dr. Lutfi Kirdar City Hospital, University of Health Sciences, Istanbul, Turkey
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Song E, Hwang J, Park SJ, Park MJ, Jang A, Choi KM, Baik SH, Yoo HJ. Impact of diabetes on emergency care of acute myocardial infarction patients during the coronavirus disease 2019 pandemic: a nationwide population-based study. Front Public Health 2023; 11:1151506. [PMID: 37181708 PMCID: PMC10169718 DOI: 10.3389/fpubh.2023.1151506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/07/2023] [Indexed: 05/16/2023] Open
Abstract
Background Although acute myocardial infarction (AMI) requires timely intervention, limited nationwide data is available regarding the association between disruption of emergency services and outcomes of patients with AMI during the coronavirus disease 2019 (COVID-19) pandemic. Moreover, whether diabetes mellitus (DM) adversely affects disease severity in these patients has not yet been investigated. Methods This nationwide population-based study analyzed 45,648 patients with AMI, using data from the national registry of emergency departments (ED) in Korea. Frequency of ED visits and disease severity were compared between the COVID-19 outbreak period (year 2020) and the control period (the previous year 2019). Results The number of ED visits by patients with AMI decreased during the first, second, and third waves of the outbreak period compared to the corresponding time period in the control period (all p-values < 0.05). A longer duration from symptom onset to ED visit (p = 0.001) and ED stay (p = 0.001) and higher rates of resuscitation, ventilation care, and extracorporeal membrane oxygen insertion were observed during the outbreak period than during the control period (all p-values < 0.05). These findings were exacerbated in patients with comorbid DM; Compared to patients without DM, patients with DM demonstrated delayed ED visits, longer ED stays, more intensive care unit admissions (p < 0.001), longer hospitalizations (p < 0.001), and higher rates of resuscitation, intubation, and hemodialysis (all p-values < 0.05) during the outbreak period. While in-hospital mortality was similar in AMI patients with and without comorbid DM during the two periods (4.3 vs. 4.4%; p = 0.671), patients with DM who had other comorbidities such as chronic kidney disease or heart failure or were aged ≥ 80 years had higher in-hospital mortality compared with those without any of the comorbidities (3.1 vs. 6.0%; p < 0.001). Conclusion During the pandemic, the number of patients with AMI presenting to the ED decreased compared with that of the previous year, while the disease severity increased, particularly in patients with comorbid DM.
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Affiliation(s)
- Eyun Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jeongeun Hwang
- Division of Medical Oncology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- Department of Biomedical Research Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Sung Joon Park
- Department of Emergency Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Min Jeong Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ahreum Jang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sei Hyun Baik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hye Jin Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
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Habib H, Prabowo Y, Sulistio S, Mulyana RM, Albar IA. The association of the COVID-19 outbreak with in-hospital mortality: A single-centre study from Indonesia. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2023; 20:101219. [PMID: 36778062 PMCID: PMC9898945 DOI: 10.1016/j.cegh.2023.101219] [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: 09/03/2022] [Revised: 12/14/2022] [Accepted: 01/10/2023] [Indexed: 02/05/2023] Open
Abstract
Objective The early outbreak period of Coronavirus Disease (COVID-19) has affected the emergency department (ED) and hospital services in many countries. This study aimed to investigate the association between COVID-19 outbreak and in-hospital mortality in Jakarta, Indonesia. Methods This retrospective cohort study was conducted in a single-centre referral hospital in Jakarta, Indonesia. Data were collected between May and October 2020. All patients who visited the ED and required inpatient care during the early COVID-19 outbreak period at the study location (March to April 2020) were included in the exposure group. All patients who visited the ED and required inpatient care during the non-outbreak period (March to April 2019) were included in the non-exposure group. In-hospital mortality was the primary outcome, whereas other variables, such as sex, age, triage categories, trauma cases, referral cases, and ED length of stay (LOS), were measured to identify confounding and effect modifications. Multivariate logistic regression analysis was performed to assess this association. Results A total of 2,808 patients during the outbreak period and 2,423 patients during the non-outbreak period participated in the study. The odds of in-hospital mortality increased during the outbreak period compared to that during the non-outbreak period (odds ratio [OR], 1.41; 95%CI 1.04-1.91; p = 0.01) after adjusting for age, sex, triage categories, trauma case, ED LOS, and interaction between the outbreak period and ED LOS. Conclusion COVID-19 outbreaks have been associated with an increased risk of in-hospital mortality in referral hospitals in Jakarta, Indonesia.
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Affiliation(s)
- Hadiki Habib
- Emergency Unit dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Division of Respirology and Critical Illness, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/dr. Cipto Mangukusumo Hospital, Jakarta, Indonesia
| | - Yogi Prabowo
- Emergency Unit dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Musculoskeletal Oncology Division, Department of Orthopaedic & Traumatology, dr.Cipto Mangunkusumo Hospital/Faculty of Medicine Universitas, Indonesia
| | - Septo Sulistio
- Emergency Unit dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Roland D, Gardiner A, Razzaq D, Rose K, Bressan S, Honeyford K, Buonsenso D, Da Dalt L, De T, Farrugia R, Parri N, Oostenbrink R, Maconochie IK, Bognar Z, Moll HA, Titomanlio L, Nijman RGG. Influence of epidemics and pandemics on paediatric ED use: a systematic review. Arch Dis Child 2023; 108:115-122. [PMID: 36162959 DOI: 10.1136/archdischild-2022-324108] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 09/05/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To assess the impact of epidemics and pandemics on the utilisation of paediatric emergency care services to provide health policy advice. SETTING Systematic review. DESIGN Searches were conducted of Medline, EMBASE, CINAHL, Scopus, Web of Science and the Cochrane Library for studies that reported on changes in paediatric emergency care utilisation during epidemics (as defined by the WHO). PATIENTS Children under 18 years. INTERVENTIONS National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies was used. MAIN OUTCOME MEASURES Changes in paediatric emergency care utilisation. RESULTS 131 articles were included within this review, 80% of which assessed the impact of COVID-19. Studies analysing COVID-19, SARS, Middle East respiratory syndrome (MERS) and Ebola found a reduction in paediatric emergency department (PED) visits, whereas studies reporting on H1N1, chikungunya virus and Escherichia coli outbreaks found an increase in PED visits. For COVID-19, there was a reduction of 63.86% (95% CI 60.40% to 67.31%) with a range of -16.5% to -89.4%. Synthesis of results suggests that the fear of the epidemic disease, from either contracting it or its potential adverse clinical outcomes, resulted in reductions and increases in PED utilisation, respectively. CONCLUSIONS The scale and direction of effect of PED use depend on both the epidemic disease, the public health measures enforced and how these influence decision-making. Policy makers must be aware how fear of virus among the general public may influence their response to public health advice. There is large inequity in reporting of epidemic impact on PED use which needs to be addressed. TRIAL REGISTRATION NUMBER CRD42021242808.
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Affiliation(s)
- Damian Roland
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Adam Gardiner
- School of Medicine, University of Leicester, Leicester, UK
| | - Darakhshan Razzaq
- Northampton General Hospital NHS Trust, Northampton, Northamptonshire, UK
| | - Katy Rose
- Department of Paediatric Emergency Medicine, St. Mary's Hospital - Imperial College NHS Healthcare Trust, London, UK
- Division of Emergency Medicine, University College London NHS Foundation Trust, London, UK
| | - Silvia Bressan
- Division of Pediatric Emergency Medicine, Università degli Studi di Padova, Padova, Italy
| | - Kate Honeyford
- Health Informatics Team, Division of Clinical Studies, Institute of Cancer Research, London, UK
| | - Danilo Buonsenso
- Department of Women, Child and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy
- Universita Cattolica del Sacro Cuore, Rome, Italy
| | - Liviana Da Dalt
- Division of Pediatric Emergency Medicine, Università degli Studi di Padova, Padova, Italy
| | - Tisham De
- Imperial College Medical School, Imperial College London, London, UK
| | - Ruth Farrugia
- Department of Child and Adolescent Health, Mater Dei Hospital, Msida, Malta
| | - Niccolo Parri
- Emergency Department & Trauma Center, Ospedale Paediatrico Meyer Firenze, Florence, Italy
| | - Rianne Oostenbrink
- Department of General Paediatrics, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Ian K Maconochie
- Department of Paediatric Emergency Medicine, St. Mary's Hospital - Imperial College NHS Healthcare Trust, London, UK
| | - Zsolt Bognar
- Department of Paediatric Emergency Medicine, Heim Pal National Paediatric Institute, Budapest, Hungary
| | - Henriette A Moll
- Department of General Paediatrics, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Luigi Titomanlio
- Pediatric Emergency Department, Hopital Universitaire Robert-Debre, Paris, France
| | - Ruud Gerard Gerard Nijman
- Department of Paediatric Emergency Medicine, St. Mary's Hospital - Imperial College NHS Healthcare Trust, London, UK
- Section of Paediatric Infectious Diseases, Imperial College London, London, UK
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The impact of the COVID-19 pandemic on ectopic pregnancy presentation and treatment: A retrospective cohort study. J Gynecol Obstet Hum Reprod 2023; 52:102508. [PMID: 36384217 PMCID: PMC9659410 DOI: 10.1016/j.jogoh.2022.102508] [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] [Received: 07/24/2022] [Revised: 10/17/2022] [Accepted: 11/12/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We examined ectopic pregnancy (EP) incidence, presentation and management, before and during the COVID-19 pandemic, and following initiation of vaccination against COVID-19. STUDY DESIGN In a single-center retrospective cohort study, we compared incidence, presentation and management of EP, between 98 women who presented during the pandemic (March 1 2020 to August 31, 2021), and 94 women diagnosed earlier (March 1 2018 to August 31, 2019). Sub-periods before and after introduction of the vaccination were compared. RESULTS Age and parity were similar between the periods. For the pandemic compared to the earlier period, the median gestational age at EP presentation was higher (6.24 ± 1.25 vs. 5.59 ± 1.24, P<0.001), and the proportions were higher of symptomatic women (42.9% vs. 27.7%, p = 0.035) and urgent laparoscopies (42.9% vs. 24.5%, p = 0.038). In a multivariable linear model, women who presented during the pandemic were more likely to undergo an urgent laparoscopy [OR 2.30, 95%CI (1.20-4.41)], P = 0.012. In urgent surgeries performed during the pandemic compared to the earlier period, the proportion of women with a hemoglobin drop >2 gr/dL was greater (60% vs. 30%, p = 0.024). Statistically significant differences were not found in sonographic or laboratory findings, in rupture or massive hemoperitoneum rates, or in the need for blood transfusion in urgent laparoscopy. Outcomes were similar before and after introduction of vaccinations. CONCLUSION During the pandemic, and even after the introduction of vaccination, women with EP were more likely to undergo urgent surgery, and blood loss was greater. This is likely due to delayed diagnosis.
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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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Appleby G, Papageorgiou V, Horter S, Wharton-Smith A, Sajjanhar T, Hemeson A, Singogo E, Cahill B, Keers S, Wicksey L, Emedo M, Yim A, Nyirenda-Nyang’wa M. Caregiver perceptions and experiences of paediatric emergency department attendance during the COVID-19 pandemic: A mixed-methods study. PLoS One 2022; 17:e0276055. [PMID: 36383622 PMCID: PMC9668109 DOI: 10.1371/journal.pone.0276055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 09/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background During the early stages of the COVID-19 pandemic, concerns were raised about reduced attendance at hospitals, particularly in paediatric emergency departments, which could result in preventable poorer outcomes and late presentations among children requiring emergency care. We aimed to investigate the impact of COVID-19 on health-seeking behaviour and decision-making processes of caregivers presenting to paediatric emergency services at a National Health Service (NHS) Trust in London. Materials and methods We conducted a mixed-methods study (survey and semi-structured interviews) across two hospital sites between November-December 2020. Data from each study were collected concurrently followed by data comparison. Results Overall, 100 caregivers participated in our study; 80 completed the survey only, two completed the interview only and 18 completed both. Our quantitative study found that almost two-thirds (63%, n = 62) of caregivers attended the department within two days of their child becoming ill. Our qualitative study identified three major themes which were underpinned by concepts of trust, safety and uncertainty and were assessed in relation to the temporal nature of the pandemic and the caregivers’ journey to care. We found most caregivers balanced their concerns of COVID-19 and a perceived “overwhelmed” NHS by speaking to trusted sources, predominantly general practitioners (GPs). Conclusion Caregivers have adapted their health-seeking behaviour throughout the pandemic as new information and guidance have been released. We identified several factors affecting decisions to attend; some existed before the pandemic (e.g., concerns for child’s health) whilst others were due to the pandemic (e.g., perceived risks of transmission when accessing healthcare services). We recommend trusted medical professionals, particularly GPs, continue to provide reassurance to caregivers to seek emergency paediatric care when required. Communicating the hospital safety procedures and the importance of early intervention to caregivers could additionally provide reassurance to those concerned about the risks of accessing the hospital environment.
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Affiliation(s)
- Gayle Appleby
- Lewisham and Greenwich NHS Trust, London, United Kingdom
| | | | - Shona Horter
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Tina Sajjanhar
- Lewisham and Greenwich NHS Trust, London, United Kingdom
| | | | | | | | - Sophie Keers
- Lewisham and Greenwich NHS Trust, London, United Kingdom
| | | | - Marylyn Emedo
- Lewisham and Greenwich NHS Trust, London, United Kingdom
| | - Alastair Yim
- Lewisham and Greenwich NHS Trust, London, United Kingdom
| | - Maggie Nyirenda-Nyang’wa
- Lewisham and Greenwich NHS Trust, London, United Kingdom
- The Infection, Immunity and Inflammation Research and Teaching Department, University College London, London, United Kingdom
- * E-mail:
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Falkenstein L, Eckel N, Kadel SB, Koenig J, Litaker D, Eichinger M. Service provision and utilisation in German paediatric primary care practices during public health crises: Protocol of the mixed-methods COVID-19 PedCare Study. BMJ Open 2022; 12:e054054. [PMID: 36220317 PMCID: PMC9556743 DOI: 10.1136/bmjopen-2021-054054] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 02/25/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Public health crises such as pandemics can cause serious disruptions to the utilisation and provision of healthcare services with negative effects on morbidity and mortality. Despite the important role of paediatric primary care in maintaining high-quality healthcare services during crises, evidence about service utilisation and provision remains limited especially in Germany. This study, therefore, explores the utilisation and provision of paediatric primary care services during the ongoing COVID-19 pandemic and their barriers and facilitators. METHODS AND ANALYSIS The study uses a convergent mixed-methods design and comprises online surveys to parents, adolescents and primary care paediatricians (PCPs) and semistructured interviews with parents and PCPs. We recruit parents and adolescents from paediatric primary care practices and PCPs via email using mailing lists of the German Professional Association of Paediatricians and the German Society of Ambulatory Primary Care Paediatrics. The parent and adolescent surveys assess, inter alia, the utilisation of paediatric primary care services and its correlates, aspects of parental and child health as well as socioeconomic characteristics. The PCP survey investigates the provision of paediatric primary care services and its correlates, aspects of PCP health as well as sociodemographic and practice characteristics. The semistructured interviews with parents and PCPs explore several aspects of the online surveys in more detail. We use descriptive statistics and generalised linear mixed models to assess service utilisation and provision and specific correlates covered in the online surveys and apply qualitative content analysis to explore barriers and facilitators of service utilisation and provision more broadly in the semistructured interviews. We will integrate findings from the quantitative and qualitative analyses at the interpretation stage. ETHICS AND DISSEMINATION The study was approved by the Medical Ethics Review Board of the Medical Faculty Mannheim at Heidelberg University (2020-650N). Study results will be published in journals with external peer-review.
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Affiliation(s)
- Lina Falkenstein
- Medical Faculty Mannheim, Center for Preventive Medicine and Digital Health Baden-Wuerttemberg, Heidelberg University, Heidelberg, Germany
| | - Nathalie Eckel
- Medical Faculty Mannheim, Center for Preventive Medicine and Digital Health Baden-Wuerttemberg, Heidelberg University, Heidelberg, Germany
| | - Simone B Kadel
- Medical Faculty Mannheim, Center for Preventive Medicine and Digital Health Baden-Wuerttemberg, Heidelberg University, Heidelberg, Germany
| | - Jochem Koenig
- Institute of Medical Biostatistics, Epidemiology and Informatics, Division of Pediatric Epidemiology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - David Litaker
- Medical Faculty Mannheim, Center for Preventive Medicine and Digital Health Baden-Wuerttemberg, Heidelberg University, Heidelberg, Germany
| | - Michael Eichinger
- Medical Faculty Mannheim, Center for Preventive Medicine and Digital Health Baden-Wuerttemberg, Heidelberg University, Heidelberg, Germany
- Institute of Medical Biostatistics, Epidemiology and Informatics, Division of Pediatric Epidemiology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
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Kang S, Park JE, Ko JW, Kim MJ, Choi YU, Shim H, Bae KS, Kim K. Outcomes improvement despite continuous visits of severely injured patients during the COVID-19 outbreak: experience at a regional trauma centre in South Korea. BMC Emerg Med 2022; 22:167. [PMID: 36203133 PMCID: PMC9540133 DOI: 10.1186/s12873-022-00726-1] [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: 06/10/2022] [Accepted: 09/23/2022] [Indexed: 01/08/2023] Open
Abstract
Background Understanding the changes in characteristics of patients who visited trauma centres during the coronavirus disease 2019 (COVID-19) pandemic is important to facilitate aneffective response. This retrospective study was conducted to analyse differences in the characteristics and outcomes of patients who visited our trauma centre between pre-COVID-19 and COVID-19 eras. Methods Medical data of trauma patients enrolled in the Korean trauma database from 1 January 2018 to 31 August 2021 were collected. The number of trauma centre visits, patient characteristics, factors associated with in-hospital intervention, and outcomes werecompared between patients in the two time periods. Propensity score matching was performed to analyse the outcomes in patients with similar characteristics and severitybetween patients in the two time periods. Results The number of emergency department (ED) trauma service visits reduced in the COVID-19 era. Based on the mean age, the patients were older in the COVID-19 era. Abbreviated injury scale (AIS) 1, AIS3, AIS5, and injury severity score (ISS) were higher in the COVID-19 era. The proportion of motor vehicle collisions decreased, whereas falls increased during the COVID-19 era. Ambulance transportation, admission to the general ward, and time from injury to ED visit significantly increased. Patient outcomes, such as hospital length of stay (LOS), intensive care unit (ICU) LOS, and duration of mechanical ventilation improved, while injury severity worsened during the COVID-19 era. After adjusting for patient characteristics and severity, similar findings were observed. Conclusion The small reduction in the number of trauma patients and visits by patients who hadhigher ISS during the COVID-19 pandemic highlights the importance of maintaining trauma service capacity and capability during the pandemic. A nationwide or nationalmulticentre study will be more meaningful to examine the impact of the COVID-19 outbreak on the changes in trauma patterns, volume, and patient outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00726-1.
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Affiliation(s)
- Sooyeon Kang
- Department of Medicine, Yonsei University Wonju College of Medicine, Wonju, 26426, Korea
| | - Ji Eun Park
- Department of Medicine, Yonsei University Wonju College of Medicine, Wonju, 26426, Korea
| | - Ji Wool Ko
- Department of Surgery, Yonsei University Wonju College of Medicine, Ilsan-ro 20, 26426, Wonju, Gangwon-do, Republic of Korea.,Regional Trauma Center, Wonju Severance Christian Hospital, Ilsan-ro 20, 26426, Wonju, Gangwon-do, Republic of Korea.,Wonju Severance Pelvic Bone Research Group, Yonsei University Wonju College of Medicine, Ilsan-ro 20, 26426, Wonju, Gangwon-do, Republic of Korea
| | - Myoung Jun Kim
- Department of Surgery, Yonsei University Wonju College of Medicine, Ilsan-ro 20, 26426, Wonju, Gangwon-do, Republic of Korea.,Regional Trauma Center, Wonju Severance Christian Hospital, Ilsan-ro 20, 26426, Wonju, Gangwon-do, Republic of Korea.,Wonju Severance Pelvic Bone Research Group, Yonsei University Wonju College of Medicine, Ilsan-ro 20, 26426, Wonju, Gangwon-do, Republic of Korea
| | - Young Un Choi
- Department of Surgery, Yonsei University Wonju College of Medicine, Ilsan-ro 20, 26426, Wonju, Gangwon-do, Republic of Korea.,Regional Trauma Center, Wonju Severance Christian Hospital, Ilsan-ro 20, 26426, Wonju, Gangwon-do, Republic of Korea.,Wonju Severance Pelvic Bone Research Group, Yonsei University Wonju College of Medicine, Ilsan-ro 20, 26426, Wonju, Gangwon-do, Republic of Korea
| | - Hongjin Shim
- Department of Surgery, Yonsei University Wonju College of Medicine, Ilsan-ro 20, 26426, Wonju, Gangwon-do, Republic of Korea.,Regional Trauma Center, Wonju Severance Christian Hospital, Ilsan-ro 20, 26426, Wonju, Gangwon-do, Republic of Korea.,Wonju Severance Pelvic Bone Research Group, Yonsei University Wonju College of Medicine, Ilsan-ro 20, 26426, Wonju, Gangwon-do, Republic of Korea
| | - Keum Seok Bae
- Department of Surgery, Yonsei University Wonju College of Medicine, Ilsan-ro 20, 26426, Wonju, Gangwon-do, Republic of Korea.,Regional Trauma Center, Wonju Severance Christian Hospital, Ilsan-ro 20, 26426, Wonju, Gangwon-do, Republic of Korea
| | - Kwangmin Kim
- Department of Surgery, Yonsei University Wonju College of Medicine, Ilsan-ro 20, 26426, Wonju, Gangwon-do, Republic of Korea. .,Regional Trauma Center, Wonju Severance Christian Hospital, Ilsan-ro 20, 26426, Wonju, Gangwon-do, Republic of Korea. .,Wonju Severance Pelvic Bone Research Group, Yonsei University Wonju College of Medicine, Ilsan-ro 20, 26426, Wonju, Gangwon-do, Republic of Korea. .,Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, 03722, Korea.
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11
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Ha JY, Sung WY. Impact of COVID-19 pandemic on emergency department length of stay and clinical outcomes of patients with severe pneumonia: A single-center observational study. Medicine (Baltimore) 2022; 101:e30633. [PMID: 36197269 PMCID: PMC9508957 DOI: 10.1097/md.0000000000030633] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We examined the impact of COVID-19 pandemic on the emergency department length of stay (EDLOS) and clinical outcomes of patients with severe pneumonia admitted to the intensive care unit (ICU) through the emergency department (ED). This single-center retrospective observational study included adult patients with pneumonia admitted to the ICU through the ED between January and December 2019 (pre-pandemic) and between March 2020 and February 2021 (during-pandemic). We compared and analyzed the EDLOS by dividing it into pre-, mid-, and post-EDLOS and in-hospital mortality of patients with pneumonia admitted to the ICU according to the time of ED visits before and during the COVID-19 pandemic. Risk factors for in-hospital mortality according to the time of ED visits were analyzed using multiple logistic regression analysis. In total, 227 patients (73 patients pre-pandemic and 154 patients during the pandemic) with pneumonia admitted to the ICU through the ED were analyzed. During the COVID-19 pandemic, pre-, mid-, and post-EDLOS increased (P < .05), and the in-hospital mortality rate increased by 10.4%; however, this was not significant (P = .155). Multivariate logistic regression analysis revealed post-EDLOS (ED waiting time after making ICU admission decision) as an independent risk factor for in-hospital mortality of patients with pneumonia admitted to the ICU, pre-pandemic (odds ratio [OR] = 2.282, 95% confidence interval [CI]: 1.367-3.807, P = .002) and during the pandemic (OR = 1.126, 95% CI: 1.002-1.266, P = .047). Mid-EDLOS (ED time to assess, care, and ICU admission decision) was an independent risk factor for in-hospital mortality of patients with pneumonia admitted to the ICU during the COVID-19 pandemic (OR = 1.835, 95% CI: 1.089-3.092, P = .023). During the pandemic of emerging respiratory infectious diseases, to reduce in-hospital mortality of severe pneumonia patients, it is necessary to shorten the ED waiting time for admission by increasing the number of isolation ICU beds. It is also necessary to accelerate the assessment and care process in the ED, and make prompt decisions regarding admission to the ICU.
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Affiliation(s)
- Jun Young Ha
- Department of Emergency Medicine, Daejeon Eulji University Hospital, Daejeon, Republic of Korea
| | - Won Young Sung
- Department of Emergency Medicine, Daejeon Eulji University Hospital, Daejeon, Republic of Korea
- *Correspondence: Won Young Sung, Department of Emergency Medicine, Daejeon Eulji University Hospital, 95 Dunsanseo-ro, Seo-gu, Daejeon 35233, Republic of Korea (e-mail: )
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Obstetrics and Gynecology Emergency Department Activity during Lockdown in a Teaching Hospital, Hub Center, for COVID-19. Obstet Gynecol Int 2022; 2022:7557628. [PMID: 36106125 PMCID: PMC9467788 DOI: 10.1155/2022/7557628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 03/02/2022] [Accepted: 07/11/2022] [Indexed: 11/18/2022] Open
Abstract
Background The lockdown related to the SARS-CoV-2 pandemic has imposed profound changes in the interaction of the population with hospitals and emergency departments. The main aim of this research was to evaluate the impact of lockdown on the activity of obstetrics and gynecology emergency department (OGED) in a teaching hospital, hub center, for COVID-19. Methods The study considers all visits to the OGED with their different triage color codes that represent the clinical severity of each case (from the most severe to the least one: red, yellow, green, white). Data were selected through the “PSNet” triage program and collected anonymously. We analyzed frequency distributions of the variables separately for each woman and calculated mean and standard deviations for continuous variables. We then analyzed the association between factors and outcomes for categorical variables (expressed as a number and percentage of the total) using the chi-square test (χ2). The level of significance was established with p < 0.05. Statistical analysis was performed using SPSS Statistics V20.0. Given the fact that the study has a retrospective observational nature and it is based on an anonymous routine database, approval by the Local Ethics Committee was not necessary. Results The relative decrease of patients presenting to OGED in 2020 was −50.96%. The percentage of nonpregnant women was significantly lower in 2020 compared to 2019 (p ≤ 0.0001; Δ = −79.46%). Regarding the obstetric group, we saw an important decrease of visits in 2020 compared to 2019 (p < 0.0001; Δ = −40%). The prevalence of yellow codes was significantly higher in 2020 (Δ = +29.72%), while that of white (Δ = −61.58%) and green (Δ = −52.22%) codes was significantly lower (p ≤ 0.0001). Comparing the diagnoses at discharge, we could highlight significant reductions in 2020 for more than one diagnosis: bleeding (p ≤ 0.0001; Δ = −70.42%), pain (p ≤ 0.0001; Δ = −81.22%), urinary diseases (p = 0.004; Δ = −75.64%), and gastrointestinal diseases (p ≤ 0.0001; Δ = −87.50%). Conclusions An evident change emerged in relation to the dynamics between the local obstetrical and gynecological population, and OGED resources. The COVID‐19 lockdown greatly reduced the rate of admission to OGED without time-related obstetric and gynecological complications. The reduction of admissions suggests a more appropriate use of the ED by patients that may inspire future policies for the implementation of emergency services.
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Presentations of children to emergency departments across Europe and the COVID-19 pandemic: A multinational observational study. PLoS Med 2022; 19:e1003974. [PMID: 36026507 PMCID: PMC9467376 DOI: 10.1371/journal.pmed.1003974] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 09/12/2022] [Accepted: 07/28/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND During the initial phase of the Coronavirus Disease 2019 (COVID-19) pandemic, reduced numbers of acutely ill or injured children presented to emergency departments (EDs). Concerns were raised about the potential for delayed and more severe presentations and an increase in diagnoses such as diabetic ketoacidosis and mental health issues. This multinational observational study aimed to study the number of children presenting to EDs across Europe during the early COVID-19 pandemic and factors influencing this and to investigate changes in severity of illness and diagnoses. METHODS AND FINDINGS Routine health data were extracted retrospectively from electronic patient records of children aged 18 years and under, presenting to 38 EDs in 16 European countries for the period January 2018 to May 2020, using predefined and standardized data domains. Observed and predicted numbers of ED attendances were calculated for the period February 2020 to May 2020. Poisson models and incidence rate ratios (IRRs), using predicted counts for each site as offset to adjust for case-mix differences, were used to compare age groups, diagnoses, and outcomes. Reductions in pediatric ED attendances, hospital admissions, and high triage urgencies were seen in all participating sites. ED attendances were relatively higher in countries with lower SARS-CoV-2 prevalence (IRR 2.26, 95% CI 1.90 to 2.70, p < 0.001) and in children aged <12 months (12 to <24 months IRR 0.86, 95% CI 0.84 to 0.89; 2 to <5 years IRR 0.80, 95% CI 0.78 to 0.82; 5 to <12 years IRR 0.68, 95% CI 0.67 to 0.70; 12 to 18 years IRR 0.72, 95% CI 0.70 to 0.74; versus age <12 months as reference group, p < 0.001). The lowering of pediatric intensive care admissions was not as great as that of general admissions (IRR 1.30, 95% CI 1.16 to 1.45, p < 0.001). Lower triage urgencies were reduced more than higher triage urgencies (urgent triage IRR 1.10, 95% CI 1.08 to 1.12; emergent and very urgent triage IRR 1.53, 95% CI 1.49 to 1.57; versus nonurgent triage category, p < 0.001). Reductions were highest and sustained throughout the study period for children with communicable infectious diseases. The main limitation was the retrospective nature of the study, using routine clinical data from a wide range of European hospitals and health systems. CONCLUSIONS Reductions in ED attendances were seen across Europe during the first COVID-19 lockdown period. More severely ill children continued to attend hospital more frequently compared to those with minor injuries and illnesses, although absolute numbers fell. TRIAL REGISTRATION ISRCTN91495258 https://www.isrctn.com/ISRCTN91495258.
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14
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Han C. Changes in mortality rate of the general population during the COVID-19 pandemic: an interrupted time series study in Korea. Int J Epidemiol 2022; 51:1396-1407. [DOI: 10.1093/ije/dyac083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/05/2022] [Indexed: 02/07/2023] Open
Abstract
Abstract
Background
Unlike other countries, South Korea did not implement a large-scale lockdown or closure of businesses to manage the coronavirus disease 2019 (COVID-19) pandemic, but relied on changes in population behaviours and early isolation and treatment of patients. It is important to evaluate the effectiveness of such alternative strategies on the mortality of the general population.
Methods
Mortality and monthly population data from 2013 to 2020 were obtained. A quasi-Poisson regression model adjusting for age structure, seasonality and time was used to evaluate whether underlying trends for monthly mortality rate have changed with the pandemic. Stratification analyses based on sex and location of deaths (inside vs outside of medical facilities) were conducted.
Results
The risk estimates showed no changes in non-accidental mortality during the COVID-19 pandemic [relative risk (RR) (95% confidence interval, 95% CI), slope change: 1.00 (1.00, 1.01), step change: 0.99 (0.97, 1.01)] compared with those before the pandemic. In cause-specific analysis, there was an abrupt and sustained decrease in the mortality rate of respiratory diseases [RR (95% CI), step change: 0.81 (0.77, 0.84)]. In the analysis of deaths by location, an increase in non-accidental mortality [RR (95% CI), slope change: 1.01 (1.01, 1.02), step change: 1.16 (1.11, 1.22)] and several cause-specific mortalities was observed outside of medical facilities.
Conclusions
The non-accidental mortality rate in South Korea for the first year of the pandemic followed the historical trends. However, there was a decrease in mortality associated with respiratory diseases, and an increase in mortality occurring outside of medical facilities. The findings may be attributed to changes in public behaviours, and availability of medical resources during the pandemic.
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Gilmartin S, Barrett M, Bennett M, Begley C, Chroinin CN, O'Toole P, Blackburn C. The effect of national public health measures on the characteristics of trauma presentations to a busy paediatric emergency service in Ireland: a longitudinal observational study. Ir J Med Sci 2022; 191:589-595. [PMID: 33743160 PMCID: PMC7980126 DOI: 10.1007/s11845-021-02593-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/07/2021] [Indexed: 10/28/2022]
Abstract
BACKGROUND The SARS-CoV-2 pandemic and government-enforced restrictions have impacted medical practices. AIMS The aim of our study was to investigate the impact SARS-CoV-2 and public health restrictions had on trauma presentations to a regional paediatric emergency service. METHODS We carried out a multisite retrospective longitudinal study of all paediatric ED attendances from 2018 including 13 March to 7 June 2020. This aligned with the initial government-enforced public health phases: delay phase, mitigation phase and reopening phase 1. RESULTS There were 7975 total regional attendances during government-enforced restrictions. This represents 17.5% and 15.6% reductions in site attendances when compared with the two previous years. Regional attendances reduced by 52.5% in 2020 compared with 2018 and 50.9% compared with 2019. Following an initial reduction in injury attendances at the beginning of the 'lockdown' (p = 0.076), the number of injuries consistently grew as weeks progressed (p < 0.05), reaching a peak of 44.6% of all attendances. As restrictions eased, the most common location where injuries occurred moved to areas outside the home (p < 0.000). There was a significant change in injury type, final disposition and device-associated injury (p < 0.05). Wheeled recreational devices were associated with over 20% of all injuries by reopening phase 1. CONCLUSIONS This study reveals that total attendances and total injuries reduced during initial phases of the lockdown. This was followed by a significant increase in injury presentations, which reached a peak of 44.6% of all attendances. We identified potential modifiable characteristics of paediatric trauma which can be addressed by future public health strategies.
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Affiliation(s)
- Stephen Gilmartin
- Department of Paediatric Emergency Medicine, Children's Health Ireland Crumlin, Dublin, Ireland.
| | - Michael Barrett
- Department of Paediatric Emergency Medicine, Children's Health Ireland Crumlin, Dublin, Ireland
- School of Medicine, Women's and Children's Health, University College Dublin, Dublin, Ireland
- National Children's Research Centre, Crumlin, Dublin, Ireland
| | - Michael Bennett
- Department of Paediatric Emergency Medicine, Children's Health Ireland Tallaght, Dublin, Ireland
| | - Cliona Begley
- Department of Paediatric Emergency Medicine, Children's Health Ireland Crumlin, Dublin, Ireland
| | - Chantelle Ni Chroinin
- Department of Paediatric Emergency Medicine, Children's Health Ireland Crumlin, Dublin, Ireland
| | - Patrick O'Toole
- Department of Trauma and Orthopaedics, Children's Health Ireland, Dublin, Ireland
| | - Carol Blackburn
- Department of Paediatric Emergency Medicine, Children's Health Ireland Crumlin, Dublin, Ireland
- School of Medicine, Women's and Children's Health, University College Dublin, Dublin, Ireland
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Savioli G, Ceresa IF, Novelli V, Ricevuti G, Bressan MA, Oddone E. How the coronavirus disease 2019 pandemic changed the patterns of healthcare utilization by geriatric patients and the crowding: a call to action for effective solutions to the access block. Intern Emerg Med 2022; 17:503-514. [PMID: 34106397 PMCID: PMC8188157 DOI: 10.1007/s11739-021-02732-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/30/2021] [Indexed: 02/06/2023]
Abstract
The geriatric population constitutes a large slice of the population of Western countries and a class of fragile patients, with greater deaths due to COVID-19. The patterns of healthcare utilization change during pandemic disease outbreaks. Identifying the patterns of changes of this particular fragile subpopulation is important for future preparedness and response. Overcrowding in the emergency department (ED) can occur because of the volume of patients waiting to be seen, delays in patient assessment or treatment in the ED, or impediments to leaving the ED once the treatment has been completed. Overcrowding has become a serious and growing issue globally, which represents a serious impediment to healthcare utilization. To estimate the rate of ED visits attributable to the outbreak and guide the planning of strategies for managing ED access or after the outbreak of transmittable respiratory diseases. This observational study was based on a retrospective review of the epidemiological and clinical records of patients aged > 75 years who visited the Foundation IRCCS Policlinic San Matteo during the first wave of COVID-19 outbreak (February 21 to May 1, 2020; pandemic group). The analysis methods included estimation of the changes in the epidemiological and clinical data from the annual baseline data after the start of the COVID-19 pandemic. Outcome measures and analysis: Primary objective is the evaluation of ED admission rate change and ED overcrowding. Secondary objectives are the evaluation of modes of ED access by reason and triage code, access types, clinical outcomes (such as admission and mortality rates). During the pandemic, ED crowding increased dramatically, although the overall number of patients decreased, in the face of a percentage increase in those with high-acuity conditions, because of changes in patient management that have prolonged length of stay (LOS) and increased rates of access block. Overcrowding during the COVID-19 pandemic can be attributed to the Access Block. Access Block solutions are hence required to prevent a recurrence of crowding to any new viral wave or new epidemic in the future.
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Affiliation(s)
- Gabriele Savioli
- Emergency Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | | | - Viola Novelli
- Medical Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giovanni Ricevuti
- Department of Drug Science, University of Pavia, Italy and, Saint Camillus International, University of Health Sciences, Rome , Italy
| | | | - Enrico Oddone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
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Chang H, Kang MW, Paek SH. Impact of the COVID-19 pandemic on emergency department utilization patterns in South Korea: A retrospective observational study. Medicine (Baltimore) 2022; 101:e29009. [PMID: 35212313 PMCID: PMC8878873 DOI: 10.1097/md.0000000000029009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 02/16/2022] [Indexed: 11/26/2022] Open
Abstract
The purpose of analyzing changes in the use of emergency departments (EDs) was to better understand how to use ED resources efficiently during infectious disease outbreaks.Our study was a retrospective observational study. We analyzed the patterns of visits of adult and pediatric patients to separate EDs during 2020 coronavirus disease 2019 (COVID-19) outbreak to know the changes in the ED utilization. We collected the patient's demographics and time of visit, patients' acuity level at triage, cause of visit, transportation used, disposition, symptom to visit time, length of stay, and top 10 most common complaints. We compared pediatric and adult EDs before and after COVID-19.The total number of patients who visited the EDs was 197,152 over 3 years. During the COVID-19 outbreak in 2020, the number of visits decreased significantly, especially the number of pediatric patients. The number of ED visits decreased in correlation with a surge in the number of confirmed COVID patients. The proportion of severe cases in pediatric emergency department (PED) visits increased, but there was no difference in adult emergency department. The number of hospitalized PED patients increased, and the number of hospitalized adult emergency department patients decreased. However, both types of ED patients increased in intensive care unit hospitalizations, proportion of deaths, and use of ambulances. The proportion of trauma patients in the PED increased significantly (P < .001). The time from symptom onset to ED visit time was reduced for patients. The ED length of stay increased in adults, and decreased for pediatric patients.COVID-19 brought about many changes to ED utilization. A greater reduction in ED utilization occurred in pediatric patients compared to adult patients. Our study showed changes in the number and characteristics of patients visiting the ED during the COVID-19 period compared to 2018 and 2019.
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Affiliation(s)
- Hyunglan Chang
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Republic of Korea
| | - Min Woo Kang
- Department of Emergency Medicine, VHS Medical Center, Seoul, Republic of Korea
| | - So Hyun Paek
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Republic of Korea
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Wolf S, Schrempf M, Vlasenko D, Schoeler C, Erckmann F, von Parpart P, Paschwitz R, Anthuber M, Sommer F. Acute Appendicitis During the COVID-19 Pandemic - Changes in Incidence and Clinical Presentation but not in Patients' Outcome. Int J Qual Health Care 2022; 34:6524257. [PMID: 35137114 PMCID: PMC8903373 DOI: 10.1093/intqhc/mzac005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/14/2021] [Accepted: 01/28/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic is an ongoing severe issue. The aim of this study was to compare the incidence, severity and treatment of acute appendicitis (AA) before and during the COVID-19 pandemic. METHODS A retrospective cohort analysis was conducted between January 2019 and April 2020 in one high-volume center. A comparison was performed between two groups (group A: patients admitted with AA before the COVID-19 pandemic; group B: patients admitted with AA at the beginning of the pandemic) in terms of the incidence of AA and clinical and pathological outcomes. The incidence of AA was also analyzed in six surrounding peripheral hospitals. RESULTS A total of 94 patients were identified, 54 in group A and 40 in group B (57% vs. 43%). Demographic data was comparable between groups. AA in group B showed a significant higher rate of histological advanced cases (10 (18.5%) group A vs. 20 (50%) group B, p=0.001) and the need for postoperative antibiotic treatment (6 (11.1%) group A vs. 11 (27.5%) group B, p=0.045). During the pandemic, a higher percentage of patients was treated at peripheral hospitals (group A: 54/111 vs. 40/126). CONCLUSION During the onset of the COVID-19 pandemic there was a significant decrease of patients with AA in a high-volume center, which showed more advanced disease of AA. This significant decrease in the high-volume center correlates with an increase in patients with AA in peripheral hospitals and represents a change in patient flow during the onset of the pandemic.
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Affiliation(s)
- Sebastian Wolf
- Department of General, Visceral, and Transplant Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Matthias Schrempf
- Department of General, Visceral, and Transplant Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Dmytro Vlasenko
- Department of General, Visceral, and Transplant Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Claus Schoeler
- Department of General and Visceral Surgery, Wertach Clinic, Schwabmuenchen, Germany
| | - Frank Erckmann
- Department of General, Visceral and Minimal-invasive Surgery, Donau-Ries-Clinics, Donauwoerth, Germany
| | - Patrick von Parpart
- Department of General and Visceral Surgery, Friedberg and Aichach Hospital, Friedberg, Germany
| | - Rieke Paschwitz
- Department of General, Visceral, Vascular and Thoracic Surgery, St. Elisabeth Hospital Dillingen, Germany
| | - Matthias Anthuber
- Department of General, Visceral, and Transplant Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Florian Sommer
- Department of General, Visceral, and Transplant Surgery, University Hospital Augsburg, Augsburg, Germany
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19
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Kim WG, Brown SD, Johnston PR, Nagler J, Jarrett DY. Emergency pediatric radiology imaging trends for non-COVID-19-related illnesses through different stages of the pandemic. Emerg Radiol 2022; 29:1-8. [PMID: 34729649 PMCID: PMC8562366 DOI: 10.1007/s10140-021-01994-3] [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: 08/16/2021] [Accepted: 10/20/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE To evaluate how the COVID-19 pandemic affected the imaging utilization patterns for non-COVID-19-related illness in a pediatric emergency department (ED). METHODS We retrospectively reviewed radiology reports for ultrasound, CT, MRI, and fluoroscopy studies performed at a pediatric ED in April from 2017 to 2021, excluding studies for respiratory symptoms and trauma. Radiology reports and medical records were reviewed to determine if patients had a positive radiology diagnosis, the type of diagnosis, and whether it required hospital admission. Results from during the pandemic were compared to predicted rates based on pre-pandemic years. RESULTS A total of 2198 imaging studies were included. During the COVID-19 pandemic, fewer ED imaging studies were performed compared to predicted. The decrease was greater in April 2020 (RR = 0.56, p < 0.001) than in April 2021 (RR = 0.80, p = 0.038). The odds of positive diagnosis was higher during the pandemic than before, and higher in 2020 (OR 2.53, p < 0.001) than in 2021 (OR 1.38, p = 0.008). The expected numbers of positive diagnoses and hospital admittances remained within the predicted range during the pandemic (p = 0.505-0.873). CONCLUSIONS Although imaging volumes decreased during the studied months of the pandemic, the number of positive findings was unchanged compared to prior years. No differences were demonstrated in the percentage of patients admitted to the hospital with positive imaging findings. This suggests that, at our institution, the pandemic did not lead to a substantial number of missed diagnoses or severely delay the diagnosis of non-COVID-related conditions. While still lower than expected, imaging volumes increased in April 2021 suggesting a return towards baseline patient behavior as the pandemic conditions improved.
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Affiliation(s)
- Wendy G Kim
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - Stephen D Brown
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Patrick R Johnston
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Joshua Nagler
- Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Delma Y Jarrett
- Department of Radiology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
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20
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Neufeld MY, Jang H, Caron E, Golz R, Brahmbhatt TS, Sanchez SE. Social Vulnerability and COVID-19: Changes in Trauma Activations at a Safety-Net Hospital. J Surg Res 2022; 276:100-109. [PMID: 35339778 PMCID: PMC8860669 DOI: 10.1016/j.jss.2022.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 01/05/2022] [Accepted: 01/28/2022] [Indexed: 11/28/2022]
Abstract
Introduction Following the declaration of the COVID-19 pandemic, there were reports of decreased trauma hospitalizations, although violent crime persisted. COVID-19 has had the greatest impact on minoritized and vulnerable communities. Decreases in traumatic events may not extend to these communities, given pandemic-related socioeconomic and psychological burdens that increase the risk of exposure to trauma and violence. Materials and methods This was a retrospective cohort study (n = 1634) of all trauma activations presenting to our institution January 1, 2020 to May 31, 2020, and same time periods in 2018 and 2019. Census tracts and associated Social Vulnerability Index quartiles were determined from patient addresses. Changes in trauma activations pre and post Massachusetts’ state-of-emergency declaration compared to a historical control were analyzed using a difference-in-differences methodology. Results Weekly all-cause trauma activations fell from 26.44 to 8.25 (rate ratio = 0.36 [0.26, 0.50]) postdeclaration, with significant difference-in-differences compared to a historical control (P < 0.0001). Nonviolent trauma activations significantly decreased from 21.11 to 5.17 after the declaration (rate ratio = 0.27 [0.37, 0.91]; P < 0.0001), whereas there was no significant decrease in violent injury (5.33 to 3.08 rate ratio = 0.69 [0.39, 1.22]; P = 0.20). Stratified by vulnerability, the most vulnerable quartile had an increased proportion of all-cause trauma postdeclaration and had no decrease in violent trauma activations following the declaration compared to the historical control (rate ratio = 0.84 [0.38-1.86]; P = 0.67). Conclusions The state-of-emergency declaration was associated with significant decreases in overall trauma, to a greater extent in nonviolent injuries. Among those living in the most socially vulnerable communities, there was no decrease in violent trauma. These findings highlight the need for violence and injury prevention programs in vulnerable communities, particularly in times of crisis.
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Affiliation(s)
- Miriam Y Neufeld
- Boston University School of Medicine, Boston, Massachusetts; Department of Surgery, Boston University School of Medicine, Boston, Massachusetts; Department of Surgery, Boston Medical Center, Boston, Massachusetts.
| | - Hyerim Jang
- Boston University School of Medicine, Boston, Massachusetts
| | - Elisa Caron
- Boston University School of Medicine, Boston, Massachusetts
| | - Reece Golz
- Department of Surgery, Boston Medical Center, Boston, Massachusetts
| | - Tejal S Brahmbhatt
- Boston University School of Medicine, Boston, Massachusetts; Department of Surgery, Boston University School of Medicine, Boston, Massachusetts; Department of Surgery, Boston Medical Center, Boston, Massachusetts
| | - Sabrina E Sanchez
- Boston University School of Medicine, Boston, Massachusetts; Department of Surgery, Boston University School of Medicine, Boston, Massachusetts; Department of Surgery, Boston Medical Center, Boston, Massachusetts
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21
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Bae W, Choi A, Kim K, Kang HM, Kim SY, Lee H, Yoo IH, Yang EA, Chun YH, Bin JH, Yoon JS, Lee SH, Kim HH, Kim S, Jeong DC. One-year changes in the pediatric emergency department caused by prolonged coronavirus disease 2019 pandemic. Pediatr Int 2022; 64:e15016. [PMID: 34606653 PMCID: PMC8661767 DOI: 10.1111/ped.15016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/09/2021] [Accepted: 09/30/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND With the coronavirus disease 2019 (COVID-19) pandemic lasting for more than a year, it is imperative to identify the associated changes in the use of emergency medical care for efficient operation of the pediatric emergency department (PED). This study was conducted to determine the long-term impact of the COVID-19 pandemic on patterns of PED visits. METHODS This is a retrospective observational study of visits to the PED of six hospitals, between January 1, 2017, and December 31, 2020. We compared changes in the characteristics of patients before and during the COVID-19 pandemic. RESULTS A total of 245 022 visits were included in this analysis. After the first case of COVID-19 was reported in Korea, we observed a significant decrease (54.2%) in PED visits compared with the annual average number of visits in the previous 3 years. Since then, the weekly number of PED visits decreased by 11.9 person/week (95% CI: -15.3--8.4, P < 0.001), which included an increase of 0.21% (95% CI: 0.15%-0.26%, P < 0.001) per week in high acuity patients. From 2017 to 2020, the proportion of infectious respiratory diseases by year was 25.9%, 27.0%, 28.6%, and 16.3%, respectively, demonstrating a significant decrease in 2020 (P < 0.001). CONCLUSIONS During the COVID-19 pandemic, the number of patient visits to PEDs continues to decline, especially among those with infectious diseases. However, the disease severity of patients has gradually increased. There has been a change in the characteristics of visits to PEDs after COVID-19 which will require an appropriate response from a long-term perspective.
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Affiliation(s)
- Woori Bae
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Arum Choi
- Department of Preventive Medicine and Public Health, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyunghoon Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Mi Kang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sae Yun Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Heayon Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Il Han Yoo
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Ae Yang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon Hong Chun
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joong Hyun Bin
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Seo Yoon
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Haak Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Hee Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sukil Kim
- Department of Preventive Medicine and Public Health, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dae Chul Jeong
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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22
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Afolalu OO, Atekoja OE, Oyewumi ZO, Adeyeye SO, Jolayemi KI, Akingbade O. Perceived impact of coronavirus pandemic on uptake of healthcare services in South West Nigeria. Pan Afr Med J 2021; 40:26. [PMID: 34733394 PMCID: PMC8531964 DOI: 10.11604/pamj.2021.40.26.28279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/25/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction the COVID-19 pandemic since its emergence has posed a great danger to the health of the general populace while impacting the Nigerian healthcare delivery significantly. Since its emergence, the health system has been stretched with overwhelming responsibilities. The study assessed health providers´ perceived impact of coronavirus pandemic on the uptake of health care services in South West Nigeria. Methods a descriptive cross-sectional design using an online structured survey was used to elicit responses from 385 Nigerian health workers selected by convenience sampling technique. Data analysis was done with the Statistical Package for Social Sciences (SPSS) version 26. Comparison of the uptake of healthcare before and during the COVID-19 pandemic was performed using the Chi-square test. Results findings revealed a significant difference between the uptake of health care prior and during the COVID-19 pandemic (χ2= 92.77, p=0.000) as 253 respondents (65.7%) reported that the hospital recorded a low turn-out of patients during the pandemic and 184 (47.8%) indicated that some of the facility units/departments were temporarily closed due to COVID-19 pandemic. Similarly, there was a significant difference between health-related conditions requiring hospital admission before and during COVID-19 pandemic (χ2=3.334 p=0.046). Factors influencing uptake of health services during the COVID-19 pandemic are: fear of nosocomial infection, fear of stigmatization, and misconception/misinformation on COVID-19 diseases and care. Conclusion the Nigerian health system in the past months has been remarkably impacted by the pandemic. This calls for immediate restructuring to maintain an equitable distribution of care, while minimizing risk to patients and health providers.
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Affiliation(s)
| | | | - Zaccheus Opeyemi Oyewumi
- Department of Nursing, Ladoke Akintola University of Technology, Open and Distance Learning Centre, Ogbomoso, Oyo State, Nigeria
| | - Semiu Opeyemi Adeyeye
- Department of Nursing, Ladoke Akintola University of Technology, Open and Distance Learning Centre, Ogbomoso, Oyo State, Nigeria
| | | | - Oluwadamilare Akingbade
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China.,Institute of Nursing Research, Nigeria
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23
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Franchina M, Blaszkowska M, Lewis J, Johnson A, Clark A, Lam G, Mackey DA. Paediatric eye injuries during a COVID-19 pandemic lockdown. Clin Exp Optom 2021; 105:637-641. [PMID: 34402757 DOI: 10.1080/08164622.2021.1964921] [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: 12/09/2022] Open
Abstract
CLINICAL RELEVANCE Eye injuries, both accidental and non-accidental, are a significant cause of long-term visual impairment in children. An understanding of when and how such injuries occur is key to development of adequate prevention strategies. BACKGROUND To evaluate accidental and non-accidental eye injuries in children presenting to the major tertiary emergency department and outpatient ophthalmology clinic in Western Australia during the nationwide COVID-19 lockdown and to determine whether the frequency or nature of these injuries differed from pre-pandemic presentations. METHODS Retrospective review of the medical records of paediatric patients presenting to the emergency department and specialist ophthalmology clinic with an ocular injury and those presenting to the hospital Child Protection Unit with physical injuries during March-August 2020 and the same period in 2019. RESULTS There was no significant difference in the total number of accidental eye injury presentations during the lockdown period despite a significant decrease in emergency department attendance overall. Closed-globe injuries were the most common accidental eye injury presentation during lockdown (70/110, 64%), followed by adnexal injuries (39/110, 35%) and open-globe injuries (1/110, 1%). In contrast, referrals to the hospital Child Protection Unit for suspicious injuries declined during lockdown. Although eye injury presentations have changed in other parts of the world since the start of the pandemic, during COVID-19 lockdown in Western Australia, accidental paediatric ocular and adnexal trauma sustained at home continues to be a significant cause for hospital attendance. Public education regarding in-home eye injury prevention must be ongoing.
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Affiliation(s)
- Maria Franchina
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Nedlands, Australia
| | - Magda Blaszkowska
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Nedlands, Australia
| | - Joel Lewis
- Department of Ophthalmology, Perth Children's Hospital, Nedlands, Australia
| | - Alice Johnson
- Department of Ophthalmology, Perth Children's Hospital, Nedlands, Australia
| | - Antony Clark
- Department of Ophthalmology, Perth Children's Hospital, Nedlands, Australia
| | - Geoffrey Lam
- Department of Ophthalmology, Perth Children's Hospital, Nedlands, Australia
| | - David A Mackey
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Nedlands, Australia
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24
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Kang S, Ahn TK, Seo YH, Suh YJ, Paik JH. Comparison of emergency department utilization trends between the COVID-19 pandemic and control period. Medicine (Baltimore) 2021; 100:e26847. [PMID: 34397892 PMCID: PMC8360451 DOI: 10.1097/md.0000000000026847] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 06/15/2021] [Accepted: 07/12/2021] [Indexed: 02/07/2023] Open
Abstract
ABSTRACT Infectious disease pandemics has a great impact on the use of medical facilities. The purpose of this study was to analyze the effects of coronavirus disease 2019 (COVID-19) on the use of emergency medical facilities in the Republic of Korea. This single-center, retrospective observational study was conducted in a tertiary teaching hospital located in Incheon Metropolitan City, Republic of Korea. We set the pandemic period as February 19, 2020 to April 18, 2020, and the control period was set to the same period in 2018 and 2019. All consecutive patients who visited the emergency department (ED) during the study period were included. Patients were divided into 3 groups according to age (pediatric patients, younger adult patients and older adult patients). The total number, demographics, clinical data, and diagnostic codes of ED patients were analyzed. The total number of ED patients in the pandemic period was lower than that in the control period, which was particularly pronounced for pediatric patients. The proportion of patients who used the 119 ambulances increased in all 3 groups (P = .002, P < .001, and P = .001), whereas the proportion of patients who visited on foot was decreased (P = .006, P < .001, and P = .027). In terms of diagnostic codes, a significant decrease was observed in the proportion of certain infectious or parasitic diseases (A00-B99), and respiratory diseases (J00-J99) in the pediatric and younger adult patient groups (P < .001 and P < .001, respectively). The COVID-19 pandemic reduced the number of ED patients; however, the proportion of patients using ambulances increased. In particular, the proportion of patients with diagnostic codes for infectious and respiratory diseases significantly decreased during the pandemic period.
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Affiliation(s)
- Soo Kang
- Department of Emergency Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Tae Kyu Ahn
- Department of Emergency Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Young Ho Seo
- Department of Emergency Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Young Ju Suh
- Department of Biomedical Sciences, Inha University School of Medicine, Incheon, Republic of Korea
| | - Jin Hui Paik
- Department of Emergency Medicine, Inha University School of Medicine, Incheon, Republic of Korea
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25
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Saalabian K, Rolle U, Friedmacher F. Impact of the Global COVID-19 Pandemic on the Incidence, Presentation, and Management of Pediatric Appendicitis: Lessons Learned from the First Wave. Eur J Pediatr Surg 2021; 31:311-318. [PMID: 34161983 DOI: 10.1055/s-0041-1731295] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The fast-evolving nature of the coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented clinical, logistical, and socioeconomical challenges for health-care systems worldwide. While several studies have analyzed the impact on the presentation and management of acute appendicitis (AA) in the adult population, there is a relative paucity of similar research in pediatric patients with AA. To date, there is some evidence that the incidence of simple AA in children may have decreased during the first lockdown period in spring 2020, whereas the number of complicated AA cases remained unchanged or increased slightly. Despite a worrying trend toward delayed presentation, most pediatric patients with AA were treated expediently during this time with comparable outcomes to previous years. Hospitals must consider their individual capacity and medical resources when choosing between operative and non-operative management of children with AA. Testing for severe acute respiratory syndrome coronavirus type 2 is imperative in all pediatric patients presenting with fever and acute abdominal pain with diarrhea or vomiting, to differentiate between multisystem inflammatory syndrome and AA, thus avoiding unnecessary surgery. During the further extension of the COVID-19 crisis, parents should be encouraged to seek medical care with their children early in order that the appropriate treatment for AA can be undertaken in a timely fashion.
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Affiliation(s)
- Kerstin Saalabian
- Department of Pediatric Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (Main), Germany
| | - Udo Rolle
- Department of Pediatric Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (Main), Germany
| | - Florian Friedmacher
- Department of Pediatric Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (Main), Germany
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26
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Sheath C, Abdelrahman M, MacCormick A, Chan D. Paediatric appendicitis during the COVID-19 pandemic. J Paediatr Child Health 2021; 57:986-989. [PMID: 33527572 PMCID: PMC8014244 DOI: 10.1111/jpc.15359] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/28/2020] [Accepted: 01/11/2021] [Indexed: 02/07/2023]
Abstract
AIM The repercussions of the pandemic on patients without COVID-19 have been well documented. Although there is evidence that adult patients present later with complicated appendicitis, the impact on the paediatric population is unknown. Therefore, the aim of this study was to assess the impact of the COVID-19 pandemic on the presentation and management of paediatric appendicitis. METHODS Data from consecutive paediatric patients admitted with right iliac fossa pain to a teaching hospital from 1 March 2020 until 30 June 2020 (COVID-19) were compared with patients admitted from 1 March 2019 until 30 June 2019 (control). RESULTS One hundred and seventy-two patients were admitted with right iliac fossa pain (control = 97, COVID-19 = 75). Seven patients had a normal diagnostic laparoscopy in the control group compared with none in the COVID-19 group. The proportion of patients diagnosed with appendicitis was significantly higher during the COVID-19 pandemic (24% vs. 10%, P = 0.03). They presented later (3 days vs. 1 day, P < 0.01) with higher inflammatory markers (white cell count 15.8 vs. 13.2 × 109 cells per litre, P = 0.02; C-reactive protein 53 vs. 27 mg/L P = 0.04). The majority of patients underwent surgery within 1 day of admission (94% COVID-19 vs. 70% control, P = 0.13). Although there was a trend towards a greater proportion of complicated appendicitis (22% vs. 10%, P = 0.6) during COVID-19, this did not affect outcomes (no morbidity in both groups, length of hospital stay 4 vs. 2.5 days, P = 0.29). CONCLUSION Despite presenting later during COVID-19, paediatric patients with appendicitis were treated expediently with good outcomes.
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Affiliation(s)
- Chloe Sheath
- Department of Upper GI SurgeryUniversity Hospital Plymouth NHS TrustPlymouthUnited Kingdom
| | - Mohamed Abdelrahman
- Department of Upper GI SurgeryUniversity Hospital Plymouth NHS TrustPlymouthUnited Kingdom
| | - Andrew MacCormick
- Department of Upper GI SurgeryUniversity Hospital Plymouth NHS TrustPlymouthUnited Kingdom
| | - David Chan
- Department of Upper GI SurgeryUniversity Hospital Plymouth NHS TrustPlymouthUnited Kingdom
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27
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Woo E, Smith AJ, Mah D, Pfister BF, Drobetz H. Increased orthopaedic presentations as a result of COVID-19-related social restrictions in a regional setting, despite local and global trends. ANZ J Surg 2021; 91:1369-1375. [PMID: 34013547 PMCID: PMC8222891 DOI: 10.1111/ans.16928] [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: 01/07/2021] [Revised: 04/07/2021] [Accepted: 04/27/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The coronavirus (COVID-19) pandemic has affected the utilisation of emergency department (ED) services worldwide. The aim of this study was to assess the impact of COVID-19-related public health measures on orthopaedic presentations to a regional Australian hospital. METHODS A case-control study was performed at a regional trauma hospital in New South Wales (NSW), Australia. Data was collected prospectively from patients that required orthopaedic review in the period corresponding to a declaration of a global pandemic to the end of the NSW lockdown, and compared with retrospective data from the corresponding period in 2019. The five-year average of orthopaedic presentations to ED during the study period were obtained for comparison. The primary outcomes were overall number of presentations, mechanism and anatomical location of injuries, operative versus non-operative management and disposition. RESULTS During the study period in 2020, presentations requiring orthopaedic review were significantly more frequent than 2019 (496 vs. 280, p < 0.0001), with more requiring admission in 2020 (p < 0.0001). The absolute number of patients managed operatively was higher (p = 0.0002) and significantly more patients were referred for community follow-up (p < 0.0001). There was a 20% increase of consults in 2020 compared to the average number of referrals during the same period in the previous five years. CONCLUSIONS Contrary to other published literature, lockdown conditions imposed during the COVID-19 pandemic resulted in a surprising 77% increase in orthopaedic presentations to this regional Australian hospital. These findings can be used to better direct resources, preparation and staff education in the current and for future pandemics.
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Affiliation(s)
- Elise Woo
- Orthopaedic DepartmentLismore Base HospitalLismoreNew South Wales2480Australia
| | | | - Dominic Mah
- School of MedicineUniversity of New South WalesKensingtonNew South Wales2052Australia
| | | | - Herwig Drobetz
- Orthopaedic DepartmentLismore Base HospitalLismoreNew South Wales2480Australia
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28
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Faccincani R, Trucco P, Nocetti C, Carlucci M, Weinstein ES. Assessing Hospital Adaptive Resource Allocation Strategies in Responding to Mass Casualty Incidents. Disaster Med Public Health Prep 2021; 16:1-9. [PMID: 34114535 DOI: 10.1017/dmp.2021.113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hospitals are expected to operate at a high performance level even under exceptional conditions of peak demand and resource disruptions. This understanding is not mature yet and there are wide areas of possible improvement. In particular, the fast mobilization and reconfiguration of resources frequently result into the severe disruption of elective activities, worsening the quality of care. This becomes particularly evident during the on-going coronavirus disease 2019 (COVID-19) pandemic. More resilient resource allocation strategies, that is, which adapt to the dynamics of the prevailing circumstance, are needed to maximize the effectiveness of health-care delivery. In this study, a simulation approach was adopted to assess and compare different hospital's adaptive resource allocation strategies in responding to a sudden onset disaster mass casualty incident (MCI). METHODS A specific set of performance metrics was developed to take into consideration multiple objectives and priorities and holistically assess the effectiveness of health-care delivery when coping with an MCI event. Discrete event simulation (DES) and system dynamics (SD) were used to model the key hospital processes and the MCI plan. RESULTS In the daytime scenario, during the recovery phase of the disaster, a gradual disengagement of resources from the emergency department (ED) to restart ordinary activities in operating rooms and wards returned the best performance. In the night scenario, the absorption capacity of the ED was evaluated by identifying the current bottleneck and assessment of the benefit of different resource mobilization strategies. CONCLUSIONS The present study offers a robust approach, effective strategies and new insights to design more resilient plans to cope with MCIs. It becomes particularly relevant when considering the risk of indirect damage of emergencies, where all the available resources are shifted from the care of the ordinary to the "disaster" patients, like during the on-going COVID-19 pandemic. Future research is needed to widen the scope of the analysis and take into consideration additional resilience capacities such as operational coordination mechanisms among multiple hospitals in the same geographic area.
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Affiliation(s)
| | - Paolo Trucco
- School of Management, Politecnico di Milano, Milano, Italy
| | | | - Michele Carlucci
- Pronto Soccorso e Chirurgia Generale e delle Urgenze, Ospedale San Raffsele, Milano, Italy
| | - Eric S Weinstein
- Research Center in Emergency and Disaster Medicine, CRIMEDIM, Novara, Italy
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Bothara RK, Raina A, Carne B, Walls T, McCombie A, Ardagh MW, Joyce LR. Paediatric presentations to Christchurch Hospital Emergency Department during COVID-19 lockdown. J Paediatr Child Health 2021; 57:877-882. [PMID: 33450120 PMCID: PMC8014123 DOI: 10.1111/jpc.15347] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/27/2020] [Accepted: 12/08/2020] [Indexed: 12/24/2022]
Abstract
AIM To describe the variation in volumes and types of paediatric presentations to a tertiary emergency department in New Zealand during the national level 4 lockdown for COVID-19. METHODS A retrospective, comparative cohort study in Christchurch Hospital Emergency Department, New Zealand. RESULTS There was a 37% reduction in all emergency presentations during the 33-day lockdown period. Paediatric presentations reduced significantly more than non-paediatric presentations (53% paediatric vs. 34% non-paediatric, P < 0.00001). The decrease in both overall and paediatric presentations was significantly different than similar periods in 2019 and 2018 (P < 0.00001). The proportion of New Zealand European paediatric presentations during lockdown increased by 6.09% (P = 0.01), while Pacific peoples decreased by 3.36% (P = 0.005). The proportion of <1-year-old presentations increased by 5.56% (P = 0.001), while 11-15 years decreased by 7.91% (P = 0.0001). Respiratory-related paediatric presentations decreased by 30% and proportional decreased by 4.92% (P = 0.001). CONCLUSION This study has identified a significant reduction in paediatric presentations to a tertiary emergency department in New Zealand during the national Alert Level 4 Lockdown for COVID-19. The proportional increase in the <1-year-old group may suggest a greater need for community-based child health services during the COVID-19 pandemic. Mental health support services may also need to adapt and expand to provide adequate psychological support for children during this crisis. Recognising the needs of these vulnerable groups will be critical during the ongoing COVID-19 pandemic in addition to informing response plans for similar events in the future.
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Affiliation(s)
| | - Aditya Raina
- Department of SurgeryUniversity of OtagoChristchurchNew Zealand
| | - Brennan Carne
- Department of SurgeryUniversity of OtagoChristchurchNew Zealand
| | - Tony Walls
- Department of PaediatricsCanterbury District Health Board (CDHB)ChristchurchNew Zealand,Department of PaediatricsUniversity of OtagoChristchurchNew Zealand
| | - Andrew McCombie
- Department of SurgeryCanterbury District Health Board (CDHB)ChristchurchNew Zealand
| | - Michael W Ardagh
- Department of SurgeryUniversity of OtagoChristchurchNew Zealand,Emergency DepartmentCanterbury District Health Board (CDHB)ChristchurchNew Zealand
| | - Laura R Joyce
- Department of SurgeryUniversity of OtagoChristchurchNew Zealand,Emergency DepartmentCanterbury District Health Board (CDHB)ChristchurchNew Zealand
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Liguoro I, Pilotto C, Vergine M, Pusiol A, Vidal E, Cogo P. The impact of COVID-19 on a tertiary care pediatric emergency department. Eur J Pediatr 2021; 180:1497-1504. [PMID: 33409588 PMCID: PMC7787709 DOI: 10.1007/s00431-020-03909-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/11/2020] [Accepted: 12/10/2020] [Indexed: 02/06/2023]
Abstract
The restrictive measures required to face the recent outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may impact patterns of healthcare utilization. Our aim was to provide an insight into the change in the use of a pediatric emergency department (ED) during the SARS-CoV-2 pandemic. The medical records of the children seen in our pediatric ED during March and April 2020 were retrospectively reviewed. Consequently, these were compared to the medical records of 2018 and 2019 from the same time period and from other control periods (January-February 2019 and 2020, and July-August 2018 and 2019). The total number of ED visits declined by 73% from 2019 to 2020 (3051 vs 818). Significant variations were observed in the distribution of children between triage categories: the proportion of patients who was given a green-code showed a 0.59-fold decrease in comparison to 2019 (95% CI 0.5-0.69), while a relative increase in the proportion of yellow codes was observed (OR 1.46, 95% CI 1.2-1.78).Conclusion: Quarantine measures significantly impacted on the total number of patients and on the reasons for visiting them in our pediatric ED. This substantial decrease in pediatric care may either be due to lower rates of acute infections because of social distancing, or to parents' or caregivers' reticence to risk exposure to SARS-CoV-2 in a health-care setting. What is known: • A recent outbreak of a novel coronavirus responsible for a severe acute respiratory syndrome is spreading globally. • Restrictive measures may impact patterns of healthcare utilization, as observed in other previous outbreaks. What is new: • This study shows significant variations in the distribution of children among triage categories during the COVID-19 pandemic. • Discharge diagnosis was significantly different as well, in particular a relative increase in the proportion of children presenting with traumatic injuries and a decrease of viral infections were observed.
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Affiliation(s)
- Ilaria Liguoro
- Department of Medical Area - DAME - Division of Pediatrics, University of Udine, P.zzale S. Maria della Misericordia, 15., 33100 Udine, Italy
| | - Chiara Pilotto
- Department of Medical Area - DAME - Division of Pediatrics, University of Udine, P.zzale S. Maria della Misericordia, 15., 33100 Udine, Italy
| | - Michela Vergine
- Department of Medical Area - DAME - Division of Pediatrics, University of Udine, P.zzale S. Maria della Misericordia, 15., 33100 Udine, Italy
| | - Anna Pusiol
- Department of Medical Area - DAME - Division of Pediatrics, University of Udine, P.zzale S. Maria della Misericordia, 15., 33100 Udine, Italy
| | - Enrico Vidal
- Department of Medical Area - DAME - Division of Pediatrics, University of Udine, P.zzale S. Maria della Misericordia, 15., 33100 Udine, Italy
| | - Paola Cogo
- Department of Medical Area - DAME - Division of Pediatrics, University of Udine, P.zzale S. Maria della Misericordia, 15., 33100 Udine, Italy
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31
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Sung HK, Paik JH, Lee YJ, Kang S. Impact of the COVID-19 Outbreak on Emergency Care Utilization in Patients with Acute Myocardial Infarction: a Nationwide Population-based Study. J Korean Med Sci 2021; 36:e111. [PMID: 33904263 PMCID: PMC8076842 DOI: 10.3346/jkms.2021.36.e111] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/25/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has impacted various aspects of daily living and has influenced the life of every individual in a unique way. Acute myocardial infarction (AMI) is associated with high morbidity and mortality; thus, timely treatment is crucial to prevent poor prognosis. Therefore, an immediate emergency department (ED) visit is required; however, no domestic studies have reported the effect of COVID-19 on ED visits by patients with AMI. Therefore, this study aimed to assess the changes in the pattern of ED visits by patients with AMI by comparing visits during the COVID-19 outbreak period to those during two control periods. METHODS This nationwide, retrospective study used registry data of the National Emergency Department Information System. The 'outbreak period' was defined as the period between February 21, 2020 and April 1, 2020, while the 'control period' was defined as the same time period in the preceding two years (2018 and 2019). The primary outcome of our study was the number of patients admitted to the ED owing to AMI during the outbreak and control periods. Secondary outcomes were time from symptom onset to ED visit, length of ED stay, and 30-day mortality following admission. RESULTS During the outbreak period, 401,378 patients visited the ED; this number was lower than that during the control periods (2018: 577,548; 2019: 598,514). The number of patients with AMI visiting the ED was lower during the outbreak period (2,221) than during 2018 (2,437) and 2019 (2,591). CONCLUSION The COVID-19 pandemic has caused a reduction in ED visits by patients with AMI. We assume that this could likely be caused by misinterpretation of AMI symptoms as symptoms of respiratory infection, fear of contracting severe acute respiratory syndrome coronavirus 2, and restrictions in accessing emergency medical care owing to overburdened healthcare facilities. This study sheds light on the fact that healthcare and emergency medical staff members must work towards eliminating hurdles due to this pandemic for patients to receive timely emergency care, which in turn will help curb the growing burden of mortality.
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Affiliation(s)
- Ho Kyung Sung
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - Jin Hui Paik
- Department of Emergency Medicine, Inha University College of Medicine, Incheon, Korea
| | - Yu Jin Lee
- Department of Emergency Medicine, Inha University College of Medicine, Incheon, Korea
| | - Soo Kang
- Department of Emergency Medicine, Inha University College of Medicine, Incheon, Korea.
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Avoidance of Healthcare Utilization in South Korea during the Coronavirus Disease 2019 (COVID-19) Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084363. [PMID: 33924096 PMCID: PMC8074259 DOI: 10.3390/ijerph18084363] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 01/10/2023]
Abstract
Avoidance of healthcare utilization among the general population during pandemic outbreaks has been observed and it can lead to a negative impact on population health. The object of this study is to examine the influence of socio-demographic and health-related factors on the avoidance of healthcare utilization during the global outbreak of a novel coronavirus (COVID-19) in 2020. Data were collected through an online survey four weeks after the Korea Centers for Disease Control and Prevention (KCDC) confirmed the first case in South Korea; 1000 subjects were included in the analysis. The logit model for regression was used to analyze the associations between sociodemographic and health-related factors regarding the avoidance of healthcare utilization. Among the participants, 73.2% avoided healthcare utilization, and there was no significant difference in the prevalence of healthcare avoidance between groups with (72.0%) and without (74.9%) an underlying disease. Sociodemographic characteristics (e.g., gender, age, income level, and residential area) were related to healthcare avoidance. Among the investigated influencing factors, residential areas highly affected by COVID-19 (i.e., Daegu/Gyeoungbuk region) had the most significant effect on healthcare avoidance. This study found a high prevalence of healthcare avoidance among the general population who under-utilized healthcare resources during the COVID-19 outbreak. However, the results reveal that not all societal groups share the burden of healthcare avoidance equally, with it disproportionately affecting those with certain sociodemographic characteristics. This study can inform healthcare under-utilization patterns during emerging infectious disease outbreaks and provide information to public health emergency management for implementing strategies necessary to improve the preparedness of the healthcare system.
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Barg M, Rotem R, Mor P, Rottenstreich M, Khatib F, Grisaru-Granovsky S, Armon S. Delayed presentation of ectopic pregnancy during the COVID-19 pandemic: A retrospective study of a collateral effect. Int J Gynaecol Obstet 2021; 153:457-461. [PMID: 33599285 DOI: 10.1002/ijgo.13647] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/26/2020] [Accepted: 02/17/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE We aimed to assess the rates of overall diagnosis of ectopic pregnancy (EP), treatment modality and associated complications during the COVID-19 pandemic compared to the exact time period in the previous year (pre-COVID-19). METHODS A retrospective cohort study was conducted at a single referral regional center (Shaare Zedek Medical Center, Jerusalem, Israel). Prevalence of the diagnosis of EP, treatment modality and associated complications during the COVID-19 lockdown period in the state of Israel (March 10-May 12, 2020) was compared to patients receiving the same diagnosis during the parallel timeframe in the previous year (2019). RESULTS Overall there were 29 and 43 cases of EP during the COVID-19 and pre COVID-19 epoch, respectively. COVID-19 period patients presented to the emergency room with significantly higher β-human chorionic gonadotrophin level; median of 1364 versus 633 IU, P = 0.001. The rate of ruptured EP was; 20.7% versus 4.3% P = 0.031, and surgical approach; 55.2% versus 27.9%, P = 0.001. Significantly higher median volume of blood loss; median volume 852 versus 300 ml, P = 0.042 were observed in patients during the COVID-19 epoch. CONCLUSION The COVID-19 pandemic led to delayed presentation of patients with EP, and the requirement of subsequent emergency surgical management and excessive blood loss. Special attention should be given to the decline in routine medical care during the pandemic.
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Affiliation(s)
- Moshe Barg
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Reut Rotem
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Pnina Mor
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Misgav Rottenstreich
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel.,Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
| | - Fayez Khatib
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Shunit Armon
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
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Bover-Bauza C, Rosselló Gomila MA, Díaz Pérez D, Millán Pons AR, Gil Sánchez JA, Peña-Zarza JA, Figuerola Mulet J, Osona B. The Impact of the SARS-CoV-2 Pandemic on the Emergency Department and Management of the Pediatric Asthmatic Patient. J Asthma Allergy 2021; 14:101-108. [PMID: 33568921 PMCID: PMC7868176 DOI: 10.2147/jaa.s284813] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/01/2021] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Asthma exacerbation is among the commonest causes for pediatric emergency room visits, and respiratory viruses are frequent triggers of such exacerbations. Few studies have evaluated the consequences of the novel human coronavirus that causes the illness currently known as COVID-19, in the pediatric population. PURPOSE The objective of this study was to analyze the impact of the COVID-19 pandemic and lockdown measures on the emergency department in the pediatric asthmatic patient. PATIENTS AND METHODS This retrospective observational study evaluated pediatric patients treated at the Pediatric Emergency Service for wheezing episodes. Changes in the number and characteristics of these patients over the same period of 2019 as compared to 2020 during the month following the alarm declaration (March 14 to April 15) were evaluated. RESULTS In total, data of 30 asthma patients managed in the period after the declaration of the coronavirus pandemic and of 158 asthma patients managed in the pre-COVID-19 period were included. In 2020, patient visits decreased by 82% in 2019. No statistically significant differences among age, sex, oxygen saturation, fever status, or number of severe bronchospasm episodes were found. Nebulized medication usage was reduced significantly since the alarm declaration. No significant increase in requests for complementary testing in the COVID-19 period was found. No patient requiring hospital admission was found to be PCR SARS-CoV-2 positive. Median time spent in the emergency department decreased from 180 minutes in 2019 to 85 minutes in the COVID-19 era. CONCLUSION The COVID-19 pandemic and ensuing lockdown measures have led to an extraordinary reduction in emergency visits to the pediatric service. The ongoing pandemic has also led to improvements in the approach to asthma exacerbations and wheezing, to reduce the risk of exposure to the virus, such as increased use of pressurized metered dose inhaler and decreased time in the Emergency Department.
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Affiliation(s)
- Catalina Bover-Bauza
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma, Balearic Islands, Spain
- Multidisciplinary Research Group in Pediatrics, Balearic Islands Health Research Institute (IdISBa), Palma, Balearic Islands, Spain
| | - Maria Antonia Rosselló Gomila
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma, Balearic Islands, Spain
| | - David Díaz Pérez
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma, Balearic Islands, Spain
| | - Aina Rosa Millán Pons
- Department of Statistic and Methodological Support, Balearic Islands Health Research Institute (IdISBa), Palma, Balearic Islands, Spain
| | - Jose Antonio Gil Sánchez
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma, Balearic Islands, Spain
- Multidisciplinary Research Group in Pediatrics, Balearic Islands Health Research Institute (IdISBa), Palma, Balearic Islands, Spain
| | - Jose Antonio Peña-Zarza
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma, Balearic Islands, Spain
- Research Group in Sleep Apnea and Hypopnea Syndrome, Balearic Islands Health Research Institute (IdISBa), Palma, Balearic Islands, Spain
| | - Joan Figuerola Mulet
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma, Balearic Islands, Spain
- Multidisciplinary Research Group in Pediatrics, Balearic Islands Health Research Institute (IdISBa), Palma, Balearic Islands, Spain
| | - Borja Osona
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma, Balearic Islands, Spain
- Multidisciplinary Research Group in Pediatrics, Balearic Islands Health Research Institute (IdISBa), Palma, Balearic Islands, Spain
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Choi DH, Jung JY, Suh D, Choi JY, Lee SU, Choi YJ, Kwak YH, Kim DK. Impact of the COVID-19 Outbreak on Trends in Emergency Department Utilization in Children: a Multicenter Retrospective Observational Study in Seoul Metropolitan Area, Korea. J Korean Med Sci 2021; 36:e44. [PMID: 33527786 PMCID: PMC7850866 DOI: 10.3346/jkms.2021.36.e44] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/12/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Understanding the changes in emergency department (ED) visit patterns during the coronavirus disease 2019 (COVID-19) outbreak is important for effectively operating EDs during the pandemic. We aimed to analyze the changes in pediatric ED visits during the COVID-19 pandemic and examine the relationship between the number of ED visits and the stringency of government social distancing measures. METHODS This multicenter retrospective study used data of pediatric (age < 18 years) ED visits in Seoul metropolitan area from June 1, 2018, to May 31, 2020. Patient demographics, ED results, and diagnoses were compared during the COVID-19 period and the previous year. To evaluate the effect of the stringency of social distancing measures on the number of ED visits, a Poisson regression model was developed with month, year, and the average monthly Government Response Stringency Index (GRSI) as fixed effects. RESULTS In total, 190,732 patients were included. The number of pediatric ED visits during the COVID-19 period was 58.1% lower than in the previous year. There were disproportionate decreases in the numbers of ED visits for children in early childhood (66.5%), low-acuity children (55.2-63.8%), those who did not use an ambulance (59.0%), and those visiting the ED for noninjury complaints (64.9%). The proportion of admissions increased from 11.9% to 16.6%. For every 10-point increase in the GRSI, there was a 15.1% decrease in monthly ED visits. CONCLUSION A striking decrease in pediatric ED visits was observed during the COVID-19 outbreak, the scale which was associated with the stringency of government policies. Changes in the number and characteristics of children visiting the ED should be considered to facilitate the effective operation of EDs during the pandemic.
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Affiliation(s)
- Dong Hyun Choi
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Dongbum Suh
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jea Yeon Choi
- Department of Emergency Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Se Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Korea
| | - Yoo Jin Choi
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
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36
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Jang KM, Ahn JY, Choi HJ, Lee S, Kim D, Lee DW, Choe JY. Pediatric Emergency Department Utilization and Coronavirus Disease in Daegu, Korea. J Korean Med Sci 2021; 36:e11. [PMID: 33398945 PMCID: PMC7781850 DOI: 10.3346/jkms.2021.36.e11] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/13/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Limited data exist on children's utilization of the emergency department (ED) in the ongoing coronavirus disease 2019 (COVID-19) pandemic. Thus, we aimed to examine ED utilization among pediatric patients and the impact of COVID-19 in one large city affected by the outbreak. METHODS This retrospective study included data from six EDs in Daegu, Korea. We compared the demographic and clinical data of patients presenting to the ED during the COVID-19 pandemic (February 1st-June 30th 2020) with those of patients who visited the ED in this period during 2018 and 2019. RESULTS Fewer patients, particularly children visited the EDs during the study period in 2020 than those in the previous (2018/2019) year period: the number of adult patient decreased by 46.4% and children by 76.9%. Although the number of patients increased from the lowest point of the decrease in March 2020, the number of pediatric patients visiting the ED remained less than half (45.2%) in June 2020 compared with that of previous years. The proportion of patients with severe conditions increased in adults, infants, and school-aged children, and consequently resulted in increased ambulance use and higher hospitalization rates. Fewer infants and young children but more school-aged children visited the ED with febrile illnesses in 2020 than in 2018/2019. CONCLUSION The COVID-19 pandemic has led to a substantial decrease in pediatric ED utilization. These findings can help reallocate human and material resources in the EDs during infectious disease outbreaks.
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Affiliation(s)
- Kyung Mi Jang
- Department of Pediatrics, Yeungnam University School of Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Ji Young Ahn
- Department of Pediatrics, Yeungnam University School of Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Hee Joung Choi
- Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea
| | - Sukhee Lee
- Department of Emergency Medicine, School of Medicine, Daegu Catholic University, Daegu, Korea
| | - Dongsub Kim
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Dong Won Lee
- Department of Pediatrics, Daegu Fatima Hospital, Korea
| | - Jae Young Choe
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
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Neufeld MY, Bauerle W, Eriksson E, Azar FK, Evans HL, Johnson M, Lawless RA, Lottenberg L, Sanchez SE, Simianu VV, Thomas CS, Drake FT. Where did the patients go? Changes in acute appendicitis presentation and severity of illness during the coronavirus disease 2019 pandemic: A retrospective cohort study. Surgery 2020; 169:808-815. [PMID: 33288212 PMCID: PMC7717883 DOI: 10.1016/j.surg.2020.10.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/16/2020] [Accepted: 10/28/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND The coronavirus disease 2019 pandemic restricted movement of individuals and altered provision of health care, abruptly transforming health care-use behaviors. It serves as a natural experiment to explore changes in presentations for surgical diseases including acute appendicitis. The objective was to determine if the pandemic was associated with changes in incidence of acute appendicitis compared to a historical control and to determine if there were associated changes in disease severity. METHODS The study is a retrospective, multicenter cohort study of adults (N = 956) presenting with appendicitis in nonpandemic versus pandemic time periods (December 1, 2019-March 10, 2020 versus March 11, 2020-May 16, 2020). Corresponding time periods in 2018 and 2019 composed the historical control. Primary outcome was mean biweekly counts of all appendicitis presentations, then stratified by complicated (n = 209) and uncomplicated (n = 747) disease. Trends in presentations were compared using difference-in-differences methodology. Changes in odds of presenting with complicated disease were assessed via clustered multivariable logistic regression. RESULTS There was a 29% decrease in mean biweekly appendicitis presentations from 5.4 to 3.8 (rate ratio = 0.71 [0.51, 0.98]) after the pandemic declaration, with a significant difference in differences compared with historical control (P = .003). Stratified by severity, the decrease was significant for uncomplicated appendicitis (rate ratio = 0.65 [95% confidence interval 0.47-0.91]) when compared with historical control (P = .03) but not for complicated appendicitis (rate ratio = 0.89 [95% confidence interval 0.52-1.52]); (P = .49). The odds of presenting with complicated disease did not change (adjusted odds ratio 1.36 [95% confidence interval 0.83-2.25]). CONCLUSION The pandemic was associated with decreased incidence of uncomplicated appendicitis without an accompanying increase in complicated disease. Changes in individual health care-use behaviors may underlie these differences, suggesting that some cases of uncomplicated appendicitis may resolve without progression to complicated disease.
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Affiliation(s)
- Miriam Y Neufeld
- Department of Surgery, Boston Medical Center/Boston University School of Medicine, MA.
| | - Wayne Bauerle
- Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Evert Eriksson
- Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Faris K Azar
- Department of Surgery, St Mary's Medical Center, West Palm Beach, FL; Department of Surgery, Florida Atlantic University, Boca Raton, FL
| | - Heather L Evans
- Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Meredith Johnson
- Department of Surgery, Virginia Mason Medical Center, Seattle, WA
| | | | - Lawrence Lottenberg
- Department of Surgery, St Mary's Medical Center, West Palm Beach, FL; Department of Surgery, Florida Atlantic University, Boca Raton, FL
| | - Sabrina E Sanchez
- Department of Surgery, Boston Medical Center/Boston University School of Medicine, MA
| | - Vlad V Simianu
- Department of Surgery, Virginia Mason Medical Center, Seattle, WA
| | | | - F Thurston Drake
- Department of Surgery, Boston Medical Center/Boston University School of Medicine, MA
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Esteban PL, Querolt Coll J, Xicola Martínez M, Camí Biayna J, Delgado-Flores L. Has COVID-19 affected the number and severity of visits to a traumatology emergency department? Bone Jt Open 2020; 1:617-620. [PMID: 33215092 PMCID: PMC7659661 DOI: 10.1302/2633-1462.110.bjo-2020-0120.r1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims To assess the impact of the declaration of the state of emergency due to the COVID-19 pandemic on the number of visits to a traumatology emergency department (ED), and on their severity. Methods Retrospective observational study. All visits to a traumatology ED were recorded, except for consultations for genitourinary, ocular and abdominal trauma and other ailments that did not have a musculoskeletal aetiology. Visit data were collected from March 14 to April 13 2020, and were subsequently compared with the visits recorded during the same periods in the previous two years. Results The number of visits dropped from a mean of 3,212 in 2018 to 2019 to 445 in 2020. Triage 1 to 3 level visits rose from 21.6% in 2018 to 2019% to 40.4% in 2020, meaning a reduction in minor injury visits and an increase in major ones. There was a relative reduction of 13.2% in femoral fractures in the elderly. The rate of justified visits rose from 22.3% to 48.1%. Conclusion A marked drop in the total number of visits to our traumatology ED was observed, as well as a relative increase in major injury visits and a relative fall in the minor ones.Cite this article: Bone Joint Open 2020;1-10:617-620.
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Affiliation(s)
- Pedro L Esteban
- Orthopaedic Department, Althaia, Xarxa Assistencial Universitária de Manresa, Manresa, Spain
| | - Jordi Querolt Coll
- Orthopaedic Department, Althaia, Xarxa Assistencial Universitária de Manresa, Manresa, Spain
| | - Marina Xicola Martínez
- Orthopaedic Department, Althaia, Xarxa Assistencial Universitária de Manresa, Manresa, Spain
| | - Joan Camí Biayna
- Orthopaedic Department, Althaia, Xarxa Assistencial Universitária de Manresa, Manresa, Spain
| | - Luis Delgado-Flores
- Orthopaedic Department, Althaia, Xarxa Assistencial Universitária de Manresa, Manresa, Spain
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McDonnell T, McAuliffe E, Barrett M, Conlon C, Cummins F, Deasy C, Hensey C, Martin C, Nicholson E. CUPID COVID-19: emergency department attendance by paediatric patients during COVID-19 - project protocol. HRB Open Res 2020; 3:37. [PMID: 32666040 PMCID: PMC7327719 DOI: 10.12688/hrbopenres.13066.2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Measures introduced to delay the spread of COVID-19 may result in avoidance of emergency departments (EDs) for non-COVID related illness. Clinicians and medical representative bodies such as the Irish Association for Emergency Medicine (IAEM) have expressed concern that some patients may not seek timely urgent medical intervention. Evidence from previous epidemics found that hospital avoidance during outbreaks of MERS and SARS was common. While ED attendance returned to normal following SARS and MERS, both outbreaks lasted 2-3 months. As the COVID-19 pandemic is forecast to extend into 2021, little is known about the impact COVID-19 will have on paediatric attendance at EDs as the pandemic evolves. Aims: This project aims to assess the impact of COVID-19 on paediatric emergency healthcare utilisation, to understand how the health seeking behaviour of parents may have altered due to the pandemic, and to identify how any barriers to accessing care can be removed. Methods: Administrative data records from five EDs across Ireland and one Urgent Care Centre will be analysed to identify temporal trends in attendances for emergency care. Qualitative inquiry will be utilised to capture the experience of staff providing emergency healthcare to paediatric patients during COVID-19, and their feedback on identified trends will inform the interpretation of findings. A cross-sectional survey of parents will capture experiences, concerns and decision-making on accessing healthcare for their children during the pandemic. Results and Conclusion: This information will help decision makers respond rapidly to meet the clinical needs of paediatric patients as the circumstances of the pandemic unfold and reduce the disruption to normal paediatric ED services during the onset of COVID-19. As the health of a child can deteriorate more rapidly than that of an adult, any delay in seeking care for an acutely ill child may have serious consequences.
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Affiliation(s)
- Thérèse McDonnell
- IRIS Centre, UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Eilish McAuliffe
- IRIS Centre, UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Michael Barrett
- Children's Health Ireland at Crumlin, Dublin, Ireland
- Women's and Children's Health, School of Medicine, University College Dublin, Dublin, Ireland
- National Children's Research Centre, Dublin, Ireland
| | - Ciara Conlon
- IRIS Centre, UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | | | | | - Conor Hensey
- Children's Health Ireland at Temple St, Dublin, Ireland
| | - Ciara Martin
- Children's Health Ireland at Tallaght, Dublin, Ireland
| | - Emma Nicholson
- IRIS Centre, UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Huang JF, Greenway MRF, Nasr DM, Chukwudelunzu FE, Demaerschalk BM, O'Carroll CB, Nord CA, Pahl EA, Barrett KM, Williams LN. Telestroke in the Time of COVID-19: The Mayo Clinic Experience. Mayo Clin Proc 2020; 95:1704-1708. [PMID: 32753143 PMCID: PMC7293444 DOI: 10.1016/j.mayocp.2020.06.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 11/17/2022]
Abstract
On March 11, 2020, the World Health Organization declared the coronavirus disease 2019 (COVID-19) a pandemic, and in the weeks following, public health organizations, medical associations, and governing bodies throughout the world recommended limiting contact with others to "flatten the curve" of COVID-19. Although both ischemic and hemorrhagic strokes have been reported with COVID-19, there has been anecdotal suggestion of an overall decrease in stroke admissions. To date, the effects of any pandemic on telestroke service lines have not been described. The purpose of this cross-sectional analysis of telestroke activations in the 30 days before and after the declaration of the COVID-19 pandemic is to describe the difference in case volumes of telestroke activations, the characteristics of patients, and treatment recommendations between the 2 time frames. We found a 50.0% reduction in total telestroke activations between the predeclaration group (142 patients) and the postdeclaration group (71 patients). There were no statistically significant differences in age (P=.95), sex (P=.10), diagnosis (P=.26), or regional variations (P=.08) in activation volumes. The percentage of patients for whom we recommended urgent stroke treatment with intravenous alteplase, mechanical thrombectomy, or both decreased from 44.4% (28 of 63) to 33.3% (11 of 33). The reasons for the sunstantial decrease in telestroke activations and urgent stroke treatment recommendations are likely multifactorial but nevertheless underscore the importance of continued public health measures to encourage patients and families to seek emergency medical care at the time of symptom onset.
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Affiliation(s)
| | | | - Deena M Nasr
- Department of Neurology, Mayo Clinic, Rochester, MN
| | | | - Bart M Demaerschalk
- Department of Neurology, Center for Connected Care, Mayo Clinic College of Medicine and Science, Rochester, MN; Department of Neurology, Mayo Clinic, Phoenix, AZ
| | | | - Charisse A Nord
- Department of Neurology, Center for Connected Care, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Emily A Pahl
- Department of Neurology, Center for Connected Care, Mayo Clinic College of Medicine and Science, Rochester, MN
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Stranger Months: How SARS-CoV-2, Fear of Contagion, and Lockdown Measures Impacted Attendance and Clinical Activity During February and March 2020 at an Urban Emergency Department in Milan. Disaster Med Public Health Prep 2020; 15:e33-e42. [PMID: 32713377 PMCID: PMC7588723 DOI: 10.1017/dmp.2020.265] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Objectives: An unprecedented wave of patients with acute respiratory failure due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease 2019 (COVID-19) hit emergency departments (EDs) in Lombardy, starting in the second half of February 2020. This study describes the direct and indirect impacts of the SARS-CoV-2 outbreak on an urban major-hospital ED. Methods: Data regarding all patients diagnosed with COVID-19 presenting from February 1 to March 31, 2020, were prospectively collected, while data regarding non-COVID patients presenting within the same period in 2019 were retrospectively retrieved. Results: ED attendance dropped by 37% in 2020. Two-thirds of this reduction occurred early after the identification of the first autochthonous COVID-19 case in Lombardy, before lockdown measures were enforced. Hospital admissions of non-COVID patients fell by 26%. During the peak of COVID-19 attendance, the ED faced an extraordinary increase in: patients needing oxygen (+239%) or noninvasive ventilation (+725%), transfers to the intensive care unit (+57%), and in-hospital mortality (+309%), compared with the same period in 2019. Conclusions: The COVID-19 outbreak determined an unprecedented upsurge in respiratory failure cases and mortality. Fear of contagion triggered a spontaneous, marked reduction of ED attendance, and, presumably, some as yet unknown quantity of missed or delayed diagnoses for conditions other than COVID-19.
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Leow SH, Dean W, MacDonald-Nethercott M, MacDonald-Nethercott E, Boyle AA. The Attend Study: A Retrospective Observational Study of Emergency Department Attendances During the Early Stages of the COVID-19 Pandemic. Cureus 2020; 12:e9328. [PMID: 32850205 PMCID: PMC7444852 DOI: 10.7759/cureus.9328] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION The coronavirus disease-19 (COVID-19) pandemic was associated with a large reduction in the number of attendances at emergency departments (EDs) in March 2020 in the United Kingdom (UK). We sought to identify which patient groups attended EDs least. METHODS Single-centre before and after study. We used routine administrative data from March 2020 and compared this to a composite control of March 2019 and February 2020. Results: Mean daily attendance fell by 30% from 342 patients per day in the composite control months to 242 patients per day in March 2020. Reductions in attendance were seen in almost all patient groups but were greatest in patients with injuries, those referred by another clinician, those arriving at the weekend, and in patients who received no investigations. Multivariate analysis revealed that the proportion of patients who were admitted to hospital fell, despite the patients being sicker, older, needing more investigations, and more likely to arrive by ambulance. DISCUSSION The reduction in ED attendances seen in the early phases of the UK pandemic occurred in all patient groups, but was greatest in the lower acuity patients. Reasons for this are complex and likely to be multifactorial.
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Affiliation(s)
- Shu Hui Leow
- Emergency Medicine, University of Cambridge, School of Clinical Medicine, Cambridge, GBR
| | - Will Dean
- Emergency Medicine, Addenbrookes Hospital, Cambridge University Hospitals Foundation Trust, Cambridge, GBR
| | | | - Eoin MacDonald-Nethercott
- Emergency Medicine, Addenbrookes Hospital, Cambridge University Hospitals Foundation Trust, Cambridge, GBR
| | - Adrian A Boyle
- Emergency Medicine, Addenbrookes Hospital, Cambridge University Hospitals Foundation Trust, Cambridge, GBR
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Abstract
Background As the novel coronavirus disease 19 (COVID-19) spreads, a decrease in the number of patients with acute appendicitis (AA) has been noted in our institutions. The aim of this study was to compare the incidence and severity of AA before and during the COVID-19 pandemic. Methods A retrospective cohort analysis was performed between December 2019 and April 2020 in the four high-volume centres that provide health care to the municipality of Jerusalem, Israel. Two groups were created. Group A consisted of patients who presented in the 7 weeks prior to COVID-19 first being diagnosed, whilst those in the 7 weeks after were allocated to Group B. A comparison was performed between the clinicopathological features of the patients in each group as was the changing incidence of AA. Results A total of 378 patients were identified, 237 in Group A and 141 in Group B (62.7% vs. 37.3%). Following the onset of COVID-19, the weekly incidence of AA decreased by 40.7% (p = 0.02). There was no significant difference between the groups in terms of the length of preoperative symptoms or surgery, need for postoperative peritoneal drainage or the distribution of complicated versus uncomplicated appendicitis. Conclusions The significant decrease in the number of patients admitted with AA during the onset of COVID-19 possibly represents successful resolution of mild appendicitis treated symptomatically by patients at home. Further research is needed to corroborate this assumption and identify those patients who may benefit from this treatment pathway.
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44
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McDonnell T, McAuliffe E, Barrett M, Conlon C, Cummins F, Deasy C, Hensey C, Martin C, Nicholson E. CUPID COVID-19: emergency department attendance by paediatric patients during COVID-19 - project protocol. HRB Open Res 2020; 3:37. [PMID: 32666040 PMCID: PMC7327719 DOI: 10.12688/hrbopenres.13066.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Measures introduced to delay the spread of COVID-19 may result in avoidance of emergency departments (EDs) for non-COVID related illness. Clinicians and medical representative bodies such as the Irish Association for Emergency Medicine (IAEM) have expressed concern that some patients may not seek timely urgent medical intervention. Evidence from previous epidemics found that hospital avoidance during outbreaks of MERS and SARS was common. While ED attendance returned to normal following SARS and MERS, both outbreaks lasted 2-3 months. As the COVID-19 pandemic is forecast to extend into 2021, little is known about the impact COVID-19 will have on paediatric attendance at EDs as the pandemic evolves. Aims: This project aims to assess the impact of COVID-19 on paediatric emergency healthcare utilisation, to understand how the health seeking behaviour of parents may have altered due to the pandemic, and to identify how any barriers to accessing care can be removed. Methods: Administrative data records from five EDs across Ireland and one Urgent Care Centre will be analysed to identify changes in attendances at emergency healthcare. Qualitative inquiry will be utilised to capture the experience of staff providing emergency healthcare to paediatric patients during COVID-19, and their feedback on identified trends will inform the interpretation of findings. A cross-sectional survey of parents will capture experiences, concerns and decision-making on accessing healthcare for their children during the pandemic. Results and Conclusion: This information will help decision makers respond rapidly to meet the clinical needs of paediatric patients as the circumstances of the pandemic unfold and reduce the disruption to normal paediatric ED services during the onset of COVID-19. As the health of a child can deteriorate more rapidly than that of an adult, any delay in seeking care for an acutely ill child may have serious consequences.
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Affiliation(s)
- Thérèse McDonnell
- IRIS Centre, UCD School of Nursng, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Eilish McAuliffe
- IRIS Centre, UCD School of Nursng, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Michael Barrett
- Children's Health Ireland at Crumlin, Dublin, Ireland
- Women's and Children's Health, School of Medicine, University College Dublin, Dublin, Ireland
- National Children's Research Centre, Dublin, Ireland
| | - Ciara Conlon
- IRIS Centre, UCD School of Nursng, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | | | | | - Conor Hensey
- Children's Health Ireland at Temple St, Dublin, Ireland
| | - Ciara Martin
- Children's Health Ireland at Tallaght, Dublin, Ireland
| | - Emma Nicholson
- IRIS Centre, UCD School of Nursng, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Kim C, Kim JK, Yeo IH, Choe JY, Lee JE, Kang SJ, Park CS, Kwon KT, Hwang S. Appendectomy in patient with suspected COVID-19 with negative COVID-19 results: A case report. World J Clin Cases 2020; 8:1944-1949. [PMID: 32518785 PMCID: PMC7262723 DOI: 10.12998/wjcc.v8.i10.1944] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 04/30/2020] [Accepted: 05/16/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Even at present, we are in the middle of the novel coronavirus disease 2019 (COVID-19) pandemic and are facing challenges in trial and error. Presently, emergency surgery for patients with suspected COVID-19 is burdensome not only for patients but also for healthcare workers. Therefore, we established a surveillance system in the emergency room and established principles for managing patients suspected of COVID-19 who require emergency surgery.
CASE SUMMARY A 67-year-old man was diagnosed with appendicitis in March 2020. His wife was diagnosed with COVID-19 10 d earlier, and the patient was in close contact with her. The patient tested negative twice on an upper respiratory COVID-19 reverse transcription–polymerase chain reaction screening test, but chest X-ray and chest computed tomography revealed patchy ground-glass opacity in both upper lobes of the patient’s lungs. The same emergency surgery procedure for patients with confirmed COVID-19 was applied to this patient suspected of having the disease to ensure that surgery was not delayed while waiting for the reverse transcription–polymerase chain reaction results. A few hours after surgery, the upper respiratory tract specimen taken in the emergency room was negative for COVID-19 but the lower respiratory tract specimen was found to be positive for the disease.
CONCLUSION When COVID-19 is suspected, emergency surgery should be performed as for confirmed COVID-19 without delay.
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Affiliation(s)
- Changho Kim
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
| | - Jong Kun Kim
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
| | - In Hwan Yeo
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
| | - Jae Young Choe
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
| | - Jeong Eun Lee
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, South Korea
| | - So Jeong Kang
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, South Korea
| | - Chan Sub Park
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, South Korea
| | - Ki Tae Kwon
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea; Department of Infection Control, Kyungpook National University Chilgok Hospital, Daegu 41944, South Korea
| | - Soyoon Hwang
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea; Department of Infection Control, Kyungpook National University Chilgok Hospital, Daegu 41944, South Korea
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Preparedness and Response to Pediatric COVID-19 in European Emergency Departments: A Survey of the REPEM and PERUKI Networks. Ann Emerg Med 2020; 76:788-800. [PMID: 32419713 PMCID: PMC7225691 DOI: 10.1016/j.annemergmed.2020.05.018] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 12/13/2022]
Abstract
Study objective We aim to describe the variability and identify gaps in preparedness and response to the coronavirus disease 2019 pandemic in European emergency departments (EDs) caring for children. Methods A cross-sectional point-prevalence survey was developed and disseminated through the pediatric emergency medicine research networks for Europe (Research in European Pediatric Emergency Medicine) and the United Kingdom and Ireland (Paediatric Emergency Research in the United Kingdom and Ireland). We aimed to include 10 EDs for countries with greater than 20 million inhabitants and 5 EDs for less populated countries, unless the number of eligible EDs was less than 5. ED directors or their delegates completed the survey between March 20 and 21 to report practice at that time. We used descriptive statistics to analyze data. Results Overall, 102 centers from 18 countries (86% response rate) completed the survey: 34% did not have an ED contingency plan for pandemics and 36% had never had simulations for such events. Wide variation on personal protective equipment (PPE) items was shown for recommended PPE use at pretriage and for patient assessment, with 62% of centers experiencing shortage in one or more PPE items, most frequently FFP2 and N95 masks. Only 17% of EDs had negative-pressure isolation rooms. Coronavirus disease 2019–positive ED staff was reported in 25% of centers. Conclusion We found variation and identified gaps in preparedness and response to the coronavirus disease 2019 epidemic across European referral EDs for children. A lack in early availability of a documented contingency plan, provision of simulation training, appropriate use of PPE, and appropriate isolation facilities emerged as gaps that should be optimized to improve preparedness and inform responses to future pandemics.
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Akuaake LM, Hendrikse C, Spittal G, Evans K, van Hoving DJ. Cross-sectional study of paediatric case mix presenting to an emergency centre in Cape Town, South Africa, during COVID-19. BMJ Paediatr Open 2020; 4:e000801. [PMID: 34192174 PMCID: PMC7509946 DOI: 10.1136/bmjpo-2020-000801] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To describe and compare the effect of level 5 lockdown measures on the workload and case mix of paediatric patients presenting to a district-level emergency centre in Cape Town, South Africa. METHODS Paediatric patients (<13 years) presenting to Mitchells Plain Hospital were included. The level 5 lockdown period (27 March 2020-30 April 2020) was compared with similar 5-week periods immediately before (21 February 2020-26 March 2020) and after the lockdown (1 May 2020-4 June 2020), and to similar time periods during 2018 and 2019. Patient demographics, characteristics, International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) diagnosis, disposition and process times were collected from an electronic patient tracking and registration database. The χ2 test and the independent samples median test were used for comparisons. RESULTS Emergency centre visits during the lockdown period (n=592) decreased by 58% compared with 2019 (n=1413) and by 56% compared with the 2020 prelockdown period (n=1342). The proportion of under 1 year olds increased by 10.4% (p<0.001), with a 7.4% increase in self-referrals (p<0.001) and a 6.9% reduction in referrals from clinics (p<0.001). Proportionally more children were referred to inpatient disciplines (5.6%, p=0.001) and to a higher level of care (3.9%, p=0.004). Significant reductions occurred in respiratory diseases (66.9%, p<0.001), injuries (36.1%, p<0.001) and infectious diseases (34.1%, p<0.001). All process times were significantly different between the various study periods. CONCLUSION Significantly less children presented to the emergency centre since the implementation of the COVID-19 lockdown, with marked reductions in respiratory and infectious-related diseases and in injuries.
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Affiliation(s)
- Lembi Magano Akuaake
- Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Clint Hendrikse
- Division of Emergency Medicine, University of Cape Town, Cape Town, Western Cape, South Africa.,Emergency Centre, Mitchells Plain Hospital and Heideveld Hospital, Cape Town, South Africa
| | - Graeme Spittal
- Paediatric Department, Mitchells Plain Hospital, Cape Town, South Africa
| | - Katya Evans
- Division of Emergency Medicine, University of Cape Town, Cape Town, Western Cape, South Africa.,Emergency Centre, Mitchells Plain Hospital and Heideveld Hospital, Cape Town, South Africa
| | - Daniël Jacobus van Hoving
- Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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48
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Lee SY, Khang YH, Lim HK. Impact of the 2015 Middle East Respiratory Syndrome Outbreak on Emergency Care Utilization and Mortality in South Korea. Yonsei Med J 2019; 60:796-803. [PMID: 31347336 PMCID: PMC6660446 DOI: 10.3349/ymj.2019.60.8.796] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/01/2019] [Accepted: 06/20/2019] [Indexed: 01/17/2023] Open
Abstract
PURPOSE In May 2015, South Korea experienced an epidemic of Middle East respiratory syndrome (MERS). This study investigated the impacts of MERS epidemic on emergency care utilization and mortality in South Korea. MATERIALS AND METHODS A natural experimental study was conducted using healthcare utilization and mortality data of the entire Korean population. The number of monthly emergency room (ER) visits was investigated to identify changes in emergency care utilization during the MERS epidemic; these trends were also examined according to patients' demographic factors, disease severity, and region. Deaths within 7 days after visiting an ER were analyzed to evaluate the impact of the reduction in ER visits on mortality. RESULTS The number of ER visits during the peak of the MERS epidemic (June 2015) decreased by 33.1% compared to the average figures from June 2014 and June 2016. The decrease was observed in all age, sex, and income groups, and was more pronounced for low-acuity diseases (acute otitis media: 53.0%; upper respiratory infections: 45.2%) than for high-acuity diseases (myocardial infarctions: 14.0%; ischemic stroke: 16.6%). No substantial changes were detected for the highest-acuity diseases, with increases of 3.5% for cardiac arrest and 2.4% for hemorrhagic stroke. The number of deaths within 7 days of an ER visit did not change significantly. CONCLUSION During the MERS epidemic, the number of ER visits decreased in all age, sex, and socioeconomic groups, and decreased most sharply for low-acuity diseases. Nonetheless, there was no significant change in deaths after emergency care.
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Affiliation(s)
- Sun Young Lee
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Young Ho Khang
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Korea
| | - Hwa Kyung Lim
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Korea
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Kim TH, Hong KJ, Shin SD, Park GJ, Kim S, Hong N. Forecasting respiratory infectious outbreaks using ED-based syndromic surveillance for febrile ED visits in a Metropolitan City. Am J Emerg Med 2018; 37:183-188. [PMID: 29779674 PMCID: PMC7126969 DOI: 10.1016/j.ajem.2018.05.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/04/2018] [Accepted: 05/08/2018] [Indexed: 11/30/2022] Open
Abstract
Background Monitoring and detecting sudden outbreaks of respiratory infectious disease is important. Emergency Department (ED)-based syndromic surveillance systems have been introduced for early detection of infectious outbreaks. The aim of this study was to develop and validate a forecasting model of respiratory infectious disease outbreaks based on a nationwide ED syndromic surveillance using daily number of emergency department visits with fever. Methods We measured the number of daily ED visits with body temperature ≥ 38.0 °C and daily number of patients diagnosed as respiratory illness by the ICD-10 codes from the National Emergency Department Information System (NEDIS) database of Seoul, Korea. We developed a forecast model according to the Autoregressive Integrated Moving Average (ARIMA) method using the NEDIS data from 2013 to 2014 and validated it using the data from 2015. We defined alarming criteria for extreme numbers of ED febrile visits that exceed the forecasted number. Finally, the predictive performance of the alarm generated by the forecast model was estimated. Results From 2013 to 2015, data of 4,080,766 ED visits were collected. 303,469 (7.4%) were ED visits with fever, and 388,943 patients (9.5%) were diagnosed with respiratory infectious disease. The ARIMA (7.0.7) model was the most suitable model for predicting febrile ED visits the next day. The number of patients with respiratory infectious disease spiked concurrently with the alarms generated by the forecast model. Conclusions A forecast model using syndromic surveillance based on the number of ED visits was feasible for early detection of ED respiratory infectious disease outbreak.
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Affiliation(s)
- Tae Han Kim
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Republic of Korea
| | - Ki Jeong Hong
- Department of Emergency Medicine, Seoul National University Hospital, Republic of Korea.
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Republic of Korea.
| | - Gwan Jin Park
- Department of Emergency Medicine, Chungbuk National University Hospital, Republic of Korea
| | - Sungwan Kim
- Institute of Medical and Biological Engineering, Seoul National University, Republic of Korea.
| | - Nhayoung Hong
- Interdisciplinary Program for Bioengineering, Graduate School, Seoul National University, Republic of Korea
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