NYU-EDA in modelling the effect of COVID-19 on patient volumes in a Finnish emergency department

Abstract

Background Emergency departments (EDs) worldwide have been in the epicentre of the novel coronavirus disease (COVID-19). However, the impact of the pandemic and national emergency measures on the number of non-COVID-19 presentations and the assessed acuity of those presentations remain uncertain. Methods We acquired a retrospective cohort containing all ED visits in a Finnish secondary care hospital during years 2018, 2019 and 2020. We compared the number of presentations in 2020 during the national state of emergency, i.e. from March 16 to June 11, with numbers from 2018 and 2019. Presentations were stratified using localized New York University Emergency Department Algorithm (NYU-EDA) to evaluate changes in presentations with different acuity levels. Results A total of 27,526 presentations were observed. Compared to previous two years, total daily presentations were reduced by 23% (from 113 to 87, p < .001). In NYU-EDA classes, Non-Emergent visits were reduced the most by 42% (from 18 to 10, p < .001). Emergent presentations were reduced by 19 to 28% depending on the subgroup (p < .001). Number of injuries were reduced by 25% (from 27 to 20, p < .001). The NYU-EDA distribution changed statistically significantly with 4% point reduction in Non-Emergent visits (from 16 to 12%, p < .001) and 0.9% point increase in Alcohol-related visits (from 1.6 to 2.5%, p < .001). Conclusions We observed a significant reduction in total ED visits in the course of national state of emergency. Presentations were reduced in most of the NYU-EDA groups irrespective of the assessed acuity. A compensatory increase in presentations was not observed in the course of the 3 month lockdown. This implies either reduction in overall morbidity caused by decreased societal activity or widespread unwillingness to seek required medical advice.

The impact of COVID-19 pandemic lockdown on the incidence and outcome of complicated appendicitis

“…Aviran et al have evaluated the changes in patient's characteristics that came to the surgical ED during the Lockdown in general and have shown that patients were presented to the ED later in the course of their diseases and a worse clinical condition. Similar findings were reported worldwide regarding this period [6,7,15,16].…”

“…Patient attendance at emergency departments around the world during the first wave of the COVID-19 pandemic declined dramatically [15][16][17][18]. This decline may be attributed to patient's trepidation of contracting the COVID-19 virus and disease at hospitals and trying to whether their illnesses by themselves at home.…”

Pediatric emergency department visits during the COVID-19 pandemic: a large retrospective population-based study

“…A Spanish study reported a reduction in pediatric ED visits during the country’s first pandemic wave, although the percentage of hospitalizations following ED visits had doubled [ 17 ]. This finding is suggestive of a tendency for parents to refrain from presenting their children at the ED during the pandemic, in absence of severe health conditions [ 18 – 21 ]. However, extensive evaluations of the impact of the COVID-19 pandemic on ED visits among children are currently lacking.…”

Short door-in-door-out time of stroke patients in need of thrombectomy in a primary stroke centre

“…In this case report on three AIS patients with very short time intervals, we did not study the median DIDO time, which may constitute a weakness. We are continuously analysing the processes of our ED [25][26][27][28] including the time intervals of the AIS patients in order to publish not only median DNTs [7,8] but also eventually median DIDO times. According to our data during the COVID-19 epidemic, there have been 14 patients with DIDO times.…”