Impact of the COVID-19 Pandemic on Emergency Department Use: Focus on Patients Requiring Urgent Revascularization

Abstract

Background The novel coronavirus (2019-nCOV) appeared in China and precipitously extended across the globe. As always, natural disasters or infectious disease outbreaks have the potential to cause emergency department (ED) volume changes. Objective We aimed to assess the influence of the Coronavirus Disease 2019 (COVID-19) pandemic on ED visits and the impact on the handling of patients requiring urgent revascularization. Methods We reviewed the charts of all patients presenting to the ED of Hospital Sainte Anne (Toulon, France) from March 23 to April 5, 2020 and compared them with those of the same period in 2019. Then we analyzed complementary data on acute coronary syndrome (ST-elevation myocardial infarction [STEMI] and non-ST-elevation myocardial infarction [NSTEMI]) and neurovascular emergencies (strokes and transient ischemic attacks). Results The total number of visits decreased by 47%. The number of people assessed as triage level 2 was 8% lower in 2020. There were five fewer cases of NSTEMI in 2020, but the same number of STEMI. The number of neurovascular emergencies increased (27 cases in 2019 compared with 30 in 2020). We observed a reduction in the delay between arrival at the ED and the beginning of coronary angiography for STEMI cases (27 min in 2019 and 22 min in 2020). In 2020, 7 more stroke patients were admitted. Conclusion The COVID-19 pandemic probably dissuaded “non-critical” patients from coming to the hospital, whereas the same number of patients with a critical illness attended the ED as attended prior to the pandemic. There does not seem to have been any effect of the pandemic on patients requiring reperfusion therapy (STEMI and stroke).

A meta‐analysis of the global impact of the COVID‐19 pandemic on stroke care & the Houston Experience

“…A total of 52 studies reporting the impact of the COVID‐19 pandemic on stroke admissions were identified for qualitative synthesis. A total of 32,640 stroke admissions from 29 studies 6‐34 were included in the meta‐analysis (Figure 1) (Supplementary Table S1) based on a similar time frame of the study period and comparison period, of which ratios were derived, depending on each criterion data availability. Compared to the prepandemic period, the mean ratio of stroke admissions during the pandemic was 70.78% [95% CI: (65.02%, 76.54%)] (Figure 2) and the mean ratio of ICH cases was 83.10% [95% CI: (71.01%, 95.17%)] (Supplementary Figure S1).…”

Impact of the COVID-19 pandemic on emergency department visits: reference center

“…Montagnon et al, also found a similar increase in the proportion of elderly patients. (13) However, while we cannot have a particular reason for this, it can have resulted from the significant reduction in the proportion of patients younger than 16 years, from 33% and 22% in 2020.…”

Decrease in the Number of Patients Presenting With ST-Segment Elevation Myocardial Infarction Across Catheterization Centers in Indonesia During the Coronavirus Disease 2019 Pandemic

“…Data on 115,716 adult emergency department visits to 108 emergency departments in the United States showed a significant reduction in the incidence of most of the serious cardiovascular events, with the exception of STEMI, in the year 2020 compared with that in 2019 ( 10 ). Similarly, no decrease in the number of patients presenting with STEMI was observed in France, and the authors of the study hypothesized that the pandemic probably dissuaded “non-critical” patients, but not those requiring reperfusion ( 11 ). In Greece, the number of patients presenting to the emergency department with acute coronary syndrome (ACS) in 2020 was significantly reduced compared to that in the previous year ( 12 ).…”