Collateral Damage: The Impact of the COVID-19 Pandemic on Acute Abdominal Emergency Presentations

Abstract

Introduction: In March 2020, the World Health Organization declared a pandemic caused by a novel coronavirus. Public information created awareness as well as concern in the general population. There has been a reported decrease in the number of patients attending emergency departments (ED) during the pandemic. This is the first study to determine differences in the types of presenting illnesses, severity, and rate of resultant surgical intervention during the pandemic. Methods and Materials: We carried out a retrospective, observational cohort study comparing two groups of patients attending the ED at our tertiary-care academic hospital. A historical comparison cohort was obtained by reviewing the number of patients referred by the ED for abdominal CT between March 15 and April 15, 2020, compared with March 15 to April 15, 2019. CT reports were reviewed; primary pathologies, complications, and subsequent surgical intervention were documented and compared between the two groups. Results: In all, 733 patients were included in the 2019 cohort, and 422 patients were included in the 2020 cohort. In 2019, 32.7% had positive CT findings, increasing to 50.5% in 2020. The number of complications increased from 7.9% to 19.7%. The rate requiring surgical intervention increased from 26.3% to 47.6% in 2020. Conclusion: To date, there is little published data regarding the presentation and severity of illnesses during the coronavirus disease 2019 pandemic. This information has important public health implications, highlighting the need to educate patients to continue to present to hospital services during such crises, including if a purported second wave of COVID-19 arises.

Effect of the COVID-19 pandemic on CT scans ordered from the emergency department for abdominal complaints

“…Rates of admission and nonsurgical interventions were not reported. Of note, the daily case burden of COVID-19 in Toronto during their study period was not specified [ 18 ].…”

Qualitative Interdisciplinary Learning Reviews of Non-COVID-19 Patients’ Journeys During the COVID-19 Pandemic

“…The opportunities for improvement identified in the ILR process were consistent with the challenges faced by healthcare workers and systems around the world in our literature review. For example, the need to first establish patients’ COVID-19 status and patients’ reluctance to seek medical care due to concerns for COVID-19 infection delayed and interrupted the usual flow of care [ 1 - 3 , 10 - 11 ]. Social distancing and visitation limitations induced psychological burdens on patients and families and impacted the recovery process [ 12 - 13 ].…”

“…Such a decrease was especially noted with certain clinical populations, for example, neurological and cardiac patients [ 8 - 9 ]. However, the proportion of these patients who needed to be hospitalized was found to be higher [ 10 ], and patients were found to present with more severe illnesses and medical complications [ 11 ], suggestive of delays in seeking medical care.…”

Impact of the COVID-19 pandemic on emergency department CT for suspected diverticulitis: A natural experiment to explain patients’ and clinicians’ assessment of risk and willingness to undergo CT scanning?

“…The COVID-19 pandemic has had a rapidly evolving impact on the U.S. healthcare system. Several studies have shown that ED imaging volume decreased substantially during the COVID-19 pandemic [3,4,6]. This contrasts with the pre-pandemic trend in ED imaging, particularly CT, which had been increasing for the past decade [14][15][16], as convincing data has shown that early CT diagnosis of certain conditions, such as appendicitis and uncomplicated diverticulitis, reduces hospital resource use and improves patient outcomes [17,18].…”

“…Imaging volumes during the initial stages of the COVID-19 pandemic decreased across all patient care settings: inpatient, outpatient and emergency [3][4][5][6]. Studies have demonstrated that emergency department (ED) visits have also dramatically decreased during this time period [7].…”