An Analysis of Changes in Emergency Department Visits After a State Declaration During the Time of COVID-19

Abstract

Study objective: In the initial period of the coronavirus disease 2019 (COVID-19) pandemic, there has been a substantial decrease in the number of patients seeking care in the emergency department. A first step in estimating the impact of these changes is to characterize the patients, visits, and diagnoses for whom care is being delayed or deferred. Methods:We conducted an observational study, examining demographics, visit characteristics, and diagnoses for all ED patient visits to an urban level 1 trauma center before and after a state emergency declaration and comparing them with a similar period in 2019. We estimated percent change on the basis of the ratios of before and after periods with respect to 2019 and the decline per week using Poisson regression. Finally, we evaluated whether each factor modified the change in overall ED visits.Results: After the state declaration, there was a 49.3% decline in ED visits overall, 35.2% (95% confidence interval À38.4 to À31.9) as compared with 2019. Disproportionate declines were seen in visits by pediatric and older patients, women, and Medicare recipients, as well as for presentations of syncope, cerebrovascular accidents, urolithiasis, and abdominal and back pain. Significant proportional increases were seen in ED visits for upper respiratory infections, shortness of breath, and chest pain. Conclusion:There have been significant changes in patterns of care seeking during the COVID-19 pandemic. Declines in ED visits, especially for certain demographic groups and disease processes, should prompt efforts to understand these phenomena, encourage appropriate care seeking, and monitor for the morbidity and mortality that may result from delayed or deferred care.

Analysis of Emergency Department Visits and Hospital Activity during Influenza Season, COVID-19 Epidemic, and Lockdown Periods in View of Managing a Future Disaster Risk: A Multicenter Observational Study

“…While in some clinical situations we observed a persistent decrease throughout the lockdown period, in others (psychiatric conditions, thoracic pain, acute coronary syndrome, atrial fibrillation, hand wounds, head trauma, headaches, abdominal pain, renal colic, urinary tract infection, acute diabetes decompensation/diabetes acid ketosis, and appendicitis) we observed a secondary increasing trend but without reaching the expected values. As has been reported, our data indicate that patients may have delayed ED visits [7][8][9][10][11] and access to emergency surgical care [11], even for conditions that might have required hospitalization, including ICU. If for traumatic pathologies we can assume a reduction of their frequency during the lockdown period, this does not seem credible for the other clinical conditions.…”

The cases not seen: Patterns of emergency department visits and procedures in the era of COVID-19

“…It is also certainly possible that some portion of care usually provided in the ED was occurring in other settings, such as through telemedicine consultations. As others have noted [10], however, it is unlikely that all of the declines observed can be attributed to a decrease in actual incidence of disease or a shift in care settings, particularly for the more severe disease states requiring procedures. Our findings therefore echo others' concerns that some patients avoided care for emergency conditions that likely warranted expedient care during the COVID-19 surge.…”

“…Nearly 60% of respondents also expressed concerns about not being able to have a visitor or guest present during their care in the ED. A number of studies have indeed shown decreased ED visits in the U.S. and other parts of the world during the COVID-19 surge, including reduced presentations of acute coronary syndromes and strokes [4][5][6][7][8][9][10][11]. An additional study found evidence of increased rates of out-of-hospital cardiac arrests, likely due to delays in care [12].…”

Volume and Acuity of Emergency Department Visits Prior To and After COVID-19

“…There are scant data regarding the change in volumes and triage acuity of patients presenting to emergency departments (EDs) prior to and after COVID-19. A recent single-center report at an urban hospital in the United States reported a 35% decline in ED visits compared with the previous year (3). A reduction in volumes, particularly among those with severe acute conditions, may lead to a higher rate of complications and higher mortality in the general population.…”