The emergency department in the COVID-19 era. Who are we missing?

Giamello, Jacopo Davide; Abram, S.E.; Bernardi, Sara; Lauria, Giuseppe

doi:10.1097/mej.0000000000000718

Cited by 84 publications

(101 citation statements)

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“…This finding is consistent with other reports on the substantial reduction in healthcare utilization in Europe and elsewhere during the current crisis [9,10]. Although a pandemic-related reduction in primary healthcare utilization for critically ill patients has been reported [7,8,11], little is known on the changes in pediatric emergency medicine thus far.…”

Section: Discussionsupporting

confidence: 91%

“…At the same time, healthcare systems in Europe and elsewhere prepared for an unprecedented health emergency by reallocating resources to care for COVID-19 patients [3][4][5][6]. Public awareness of the pandemic was associated with a vast reduction in healthcare utilization in Italy and other countries [7][8][9][10]. As a result, increased adult and pediatric morbidity and mortality due to delayed healthcare utilization were reported [11,12].…”

Section: Introductionmentioning

confidence: 99%

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COVID-19 related reduction in pediatric emergency healthcare utilization – a concerning trend

et al. 2020

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Background The COVID-19 pandemic has disrupted healthcare systems worldwide. In addition to the direct impact of the virus on patient morbidity and mortality, the effect of lockdown strategies on health and healthcare utilization have become apparent. Little is known on the effect of the pandemic on pediatric and adolescent medicine. We examined the impact of the pandemic on pediatric emergency healthcare utilization. Methods We conducted a monocentric, retrospective analysis of n = 5,424 pediatric emergency department visits between January 1st and April 19th of 2019 and 2020, and compared healthcare utilization during the pandemic in 2020 to the same period in 2019. Results In the four weeks after lockdown in Germany began, we observed a massive drop of 63.8% in pediatric emergency healthcare utilization (mean daily visits 26.8 ± SEM 1.5 in 2019 vs. 9.7 ± SEM 1 in 2020, p < 0.005). This drop in cases occurred for both communicable and non-communicable diseases. A larger proportion of patients under one year old (daily mean of 16.6% ±SEM 1.4 in 2019 vs. 23.1% ±SEM 1.7 in 2020, p < 0.01) and of cases requiring hospitalisation (mean of 13.9% ±SEM 1.6 in 2019 vs. 26.6% ±SEM 3.3 in 2020, p < 0.001) occurred during the pandemic. During the analysed time periods, few intensive care admissions and no fatalities occurred. Conclusions Our data illustrate a significant decrease in pediatric emergency department visits during the COVID-19 pandemic. Public outreach is needed to encourage parents and guardians to seek medical attention for pediatric emergencies in spite of the pandemic.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

COVID-19 related reduction in pediatric emergency healthcare utilization – a concerning trend

et al. 2020

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“…Our data demonstrate a signi cant decrease in pediatric ED visits during SARS-CoV-2/COVID-19 associated lockdown in Germany. This nding is consistent with other reports on the substantial reduction in healthcare utilization in Europe and elsewhere during the current crisis [9,10]. Although a pandemic related reduction in primary healthcare utilization for critically ill patients has been reported [7,8,11], little is known on the changes in pediatric emergency medicine thus far.…”

Section: Discussionsupporting

confidence: 91%

Covid-19 Related Reduction in Paediatric Emergency Healthcare Utilization – A Concerning Trend

Happle

Dopfer

Wetzke

et al. 2020

Preprint

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Background:The COVID-19 pandemic has disrupted healthcare systems worldwide. Besides the direct impact of the virus on morbidity and mortality of patients, the effect of lockdown strategies on health and healthcare utilization become more and more apparent. Little is known on the effect of the pandemic on pediatric healthcare utilization. We examined the impact of the pandemic on pediatric emergency healthcare.Methods: We conducted a monocentric, retrospective analysis of n=5.424 pediatric emergency visits between January 1st and April 19th of 2019 and 2020, and compared healthcare utilization in the month post lockdown 2020 to the same period in 2019.Results: In the four weeks after lockdown in Germany began, we observed a massive drop of 63.8% in pediatric emergency healthcare utilization (mean daily visits 26.8 ±SEM 1.5 in 2019 vs. 9.7 ±SEM 1 in 2020, p<0.005). This drop in cases occurred for both communicable and non-communicable diseases. A larger proportion of patients under one year old (daily mean of 16.6% ±SEM 1.4 in 2019 vs 23.1% ±SEM 1.7, p<0.01 in 2020) and of cases requiring hospitalisation (mean of 13.9% ±SEM 1.6 in 2019 vs. 26.6% ±SEM 3.3 in 2020, p<0.001) occurred during the pandemic. During the analysed time periods, few intensive care admissions and no fatalities occurred.Conclusion: Our data illustrate a significant decrease in pediatric emergency room visits during the COVID-19 pandemic. Public outreach is needed to encourage parents to seek medical attention for pediatric emergencies in spite of the pandemic.

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“…Our results confirm previously published data indicating increased ED and hospital activity during influenza epidemics [19,20]. During COVID-epidemic, a 50% to 68% reduction in ED visits [7,11] and an increase of hospitalizations in Italy from 22 to 44% were reported [7]. A very recent monocentric study was conducted in Bern, Switzerland, in March 2020.…”

Section: Discussionsupporting

confidence: 91%

“…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.…”

Section: Discussionsupporting

confidence: 76%

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

Casalino

Choquet

Bouzid

et al. 2020

IJERPH

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ED-visits and through-ED admissions to medical/surgical wards (MSW) and intensive care unit (ICU) during influenza, COVID-19 and lockdown periods were evaluated in a four-hospital prospective observational study from November 2018 to March 2020. ED visit characteristics and main diagnostic categories were assessed. Analysis of 368,262 ED-visits highlighted a significantly increasing trend in ED-visits during influenza followed by a significantly decreasing trend after lockdown. For MSW-admissions, a pattern of growth during influenza was followed by a fall that began during COVID-19 pandemic and intensified during the lockdown. For ICU-admissions, a significant rise during the COVID-19 pandemic was followed by diminution during the lockdown period. During lockdown, significantly diminishing trends were shown for all diagnostic categories (between −40.8% and −73.6%), except influenza-like illness/COVID cases (+31.6%), Pulmonary embolism/deep vein thrombosis (+33.5%) and frequent users (+188.0%). The present study confirms an increase in demand during the influenza epidemic and during the initial phase of the COVID-19 epidemic, but a drop in activity during the lockdown, mainly related to non-COVID conditions. Syndromic surveillance of ILI cases in ED is a tool for monitoring influenza and COVID-19, and it can predict ED activity and the need for MSW and ICU beds.

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The emergency department in the COVID-19 era. Who are we missing?

Cited by 84 publications

References 0 publications

COVID-19 related reduction in pediatric emergency healthcare utilization – a concerning trend

COVID-19 related reduction in pediatric emergency healthcare utilization – a concerning trend

Covid-19 Related Reduction in Paediatric Emergency Healthcare Utilization – A Concerning Trend

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

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