Comparison of presentations to the emergency department during the COVID-19 pandemic (COPED-C)

Kociejowski, A; Hobart, C; Jina, Raeesa; Aberman, I; Backhurst, E; Beaumont, A.; Crompton, James; Sneep, Ruth; Cantle, Fleur; Dodhia, Hiten

doi:10.1093/pubmed/fdab059

Cited by 13 publications

(8 citation statements)

References 3 publications

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“…Of them, the number of patients with fever decreased by 19.5% (931 during the pre-COVID-19 vs. 749 during the COVID-19 period). This trend was similar to that reported in previous studies [17,18]. The major contributing factor for the decrease in ED visits during the pandemic was probably the fear of patients being exposed to COVID-19.…”

Section: Discussionsupporting

confidence: 90%

Comparison of the Clinical Process and Outcomes in Patients after Coronavirus Infection 2019 Outbreak

et al. 2021

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Background and Objectives: The coronavirus infection 2019 (COVID-19) pandemic has affected emergency department (ED) management. Its viral transmission necessitates the use of isolation rooms and personal protective equipment for treating suspected patients, such as those with fever. This delays the time until the first encounter with the patients, thereby increasing the length of stay (LOS) in the ED. We aimed to compare delays in the ED LOS and clinical processes between the COVID-19 period and pre-COVID-19 period. Moreover, we intended to evaluate if the aforementioned delay affected patient outcomes. Materials and Methods: We conducted a single-center, retrospective study in Korea. Patients with fever were compared between the “COVID-19 period” from March 2020 to August 2020 and the “pre-COVID-19 period” from March 2019 to September 2019. We compared the overall ED LOS and individual time variable, including initial diagnostic tests (laboratory tests, radiography), specific diagnostic test (computed tomography), and treatment processes (antibiotics). A logistic regression analysis was conducted to identify the association between hospital admission and patient data. Results: We enrolled 931 and 749 patients during pre- and COVID-19 periods, respectively. Patients with fever remained in the ED for a longer duration during the COVID-19 period (pre-COVID-19:207.7 ± 102.7 min vs. during COVID-19: 223.5 ± 119.4 min, p = 0.004). The total time for performing laboratory tests and radiography displayed significant differences between the two periods, particularly from the time of patient arrival in the ED to the time of issuing the order. The time until antibiotic administration was delayed in the COVID-19 period (pre-COVID-19:195.8 ± 103.3 min vs. during COVID-19: 216.9 ± 108.4 min, p = 0.003). The logistic regression analysis for hospital admission identified ED LOS as an independent factor in both periods. Conclusions: The delay until encountering patients with fever resulted in longer ED LOS during the COVID-19 period; however, it possibly did not increase the hospital admission rates.

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Section: Discussionsupporting

confidence: 90%

Comparison of the Clinical Process and Outcomes in Patients after Coronavirus Infection 2019 Outbreak

et al. 2021

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“…8 A drop in secondary care service utilisation for other conditions during the first few months of the COVID-19 pandemic/restrictions has been evidenced in a range of studies. [14][15][16][17] However, a Welsh study examining both primary care and secondary care contacts for self-harm during the pandemic found primary care contacts with self-harm reduced disproportionately compared with non-self-harm contacts, suggesting a reduction in help-seeking behaviour within this cohort, which may be reflected in the decrease in presentations observed in this study. 7 However, after stratification, there were differences observed in the demographic profile of those presenting with self-harm or ideation, with slightly fewer men than women presenting, presentations remaining unaffected in individuals aged over 65 years and those who live alone or in affluent areas and presentations appearing to increase in those aged under 16 years.…”

Section: Main Findingsmentioning

confidence: 48%

Impact of the COVID-19 pandemic on self-harm and self-harm/suicide ideation: population-wide data linkage study and time series analysis

Paterson,

Kent,

O'Reilly

et al. 2023

Br J Psychiatry

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Background The COVID-19 pandemic and associated lockdowns were predicted to have a major impact on suicidal behaviour, including self-harm. However, current studies have produced contradictory findings with limited trend data. Aims Nine years of linked individual-level administrative data were utilised to examine changes in hospital-presenting self-harm and ideation (thoughts of self-harm or suicide) before and during the pandemic. Method National self-harm registry data were linked to demographic and socioeconomic indicators from healthcare registration records (n = 1 899 437). Monthly presentations of self-harm or ideation were split (pre-COVID-19 restrictions: April 2012 to February 2020; and during restrictions: March to September 2020). Auto-regressive integrated moving average (ARIMA) models were trained in R taking into consideration trends and seasonal effects. Forecast (‘expected’) monthly values were compared with ‘actual’ values, stratified by demographic factors and method of harm. Results The number of individuals presenting with self-harm or ideation dropped significantly at the beginning of the pandemic (March–May 2020), before returning mostly to expected trends from June 2020. Stratified analysis showed similar presentation trends across most demographic subgroups except for those aged over 65 years, living alone or in affluent areas, where presentations remained unaffected, and those aged under 16 years, where numbers presenting with self-harm or ideation increased above expected levels. Conclusions Although population trends show an overall drop in presentations before a return to ‘normal’ from June 2020, the demographic profile of those presenting with self-harm or ideation varied significantly, with increases in children under the age of 16 years. This highlights important potential target groups who may have been most negatively affected by the pandemic.

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“…As in other UK EDs during the COVID‐19 pandemic, 27 attendances dropped significantly in 2020. Neonatal attendances, although fewer than in 2019, did not decrease to the same extent; however, the proportion admitted showed a continued decrease.…”

Section: Discussionmentioning

confidence: 86%

Retrospective observational study of neonatal attendances to a children's emergency department

2021

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Aim Attendances to emergency departments (EDs) in the UK are increasing, particularly for younger children. Community services are under increasing pressure and parents may preferentially bring their babies to the ED, even for non‐urgent problems. This study aimed to characterise the presenting features, management and disposition of neonatal attendances to a children's ED (CED). Methods Retrospective observational review of neonatal attendances (≤28 days) to the CED at Bristol Royal Hospital for Children (BRHC) from 01/01/2016 to 31/12/2016. Further information was obtained from investigation results and discharge summaries. Data abstracted included sex, age, referral method, presenting complaint, diagnosis, investigations and treatments. Results Neonatal attendances increased from 655 to 1,205 from 2008 to 2016. The most common presenting complaints were breathing difficulty (18.1%) and vomiting (8.3%). The most common diagnoses were ‘no significant medical problem’ (41.9%) and bronchiolitis (10.5%). Half of neonatal attendances to the CED had no investigations performed and most (77.7%) needed advice or observation only. Conclusion Many neonates presenting to the CED were well and discharged with observation only. This suggests potential for improving community management and in supporting new parents. Drivers of health policy should consider developing enhanced models of out of hospital care which are acceptable to clinicians and families.

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Comparison of presentations to the emergency department during the COVID-19 pandemic (COPED-C)

Cited by 13 publications

References 3 publications

Comparison of the Clinical Process and Outcomes in Patients after Coronavirus Infection 2019 Outbreak

Comparison of the Clinical Process and Outcomes in Patients after Coronavirus Infection 2019 Outbreak

Impact of the COVID-19 pandemic on self-harm and self-harm/suicide ideation: population-wide data linkage study and time series analysis

Retrospective observational study of neonatal attendances to a children's emergency department

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