Emergency Department Visits for Serious Diagnoses During the COVID-19 Pandemic
Emergency Department Visits for Serious Diagnoses During the COVID-19 Pandemic
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DOI：
10.1111/acem.14099
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发表时间：
2020-08-17
影响因子：
4.4
通讯作者：
McCarthy, Danielle M.
中科院分区：
文献类型：
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作者：
Kim, Howard S.;Cruz, Daniel S.;McCarthy, Danielle M.
2019冠状病毒病（COVID-19）大流行严重影响了美国的医疗保健利用率。尽管减少常规门诊就诊和择期手术是有意为COVID-19相关数量的增加做准备，1但国家综合征监测项目的数据表明，在大流行的早期阶段，每周急诊科（艾德）就诊减少了42%。2这种减少可能是由于公众害怕寻求护理，3，4最终推迟了对时间敏感的严重疾病的干预。一组美国医院最近报告称，ST段抬高型心肌梗死（STEMI）激活减少了38%，5国家神经影像学数据库显示，接受卒中成像的患者减少了39%。6为了更全面地了解COVID-19大流行对急诊护理的影响，我们试图描述其他需要紧急干预或住院治疗的严重诊断的艾德就诊趋势。我们对位于伊利诺伊州大芝加哥的一个大型卫生系统中的7个急诊室的成人就诊进行了一项横断面研究，2019年的就诊量为308，000人次。这七家ED包括一家城市学术医院、五家郊区社区医院和一家独立ED。其他医院特征见数据补充S1附录S1（，可作为本文在线版的支持信息，可在http：//onlinelibrium上查阅。怀尔河com/doi/10.1111/acem。我们测量了2019冠状病毒病大流行早期（2020年3月8日至5月2日）（包括世界卫生组织于2020年3月11日宣布大流行的时间段，直至数据收集日期）因严重诊断而前往艾德就诊的频率。然后，我们将这一早期大流行期与大流行前期（2019年12月31日至2020年3月7日）和上一年的历史控制期（2019年3月10日至2019年4月27日）进行了比较。因此，总研究持续时间为2019年3月10日至2020年5月2日。这项研究得到了西北大学机构审查委员会的批准。我们通过多轮共识驱动的讨论，选择了一组有限的与紧急护理需求相关的严重诊断。这一过程的指导原则是优先选择需要时间敏感干预的疾病（例如，急性心肌梗死）或需要及时治疗以防止临床恶化（例如，胃肠道出血）。此外，我们还需要限制诊断总数，以保持有意义的数据可视化，并最大限度地减少仅通过多重比较实现统计学显著性的风险。我们没有纳入基于胸痛的诊断（例如胸痛），因为这些诊断根据定义是非特异性的。
The coronavirus disease 2019 (COVID-19) pan-demic has significantly affected health care utilization in the United States. Although reductions in routine outpatient visits and elective procedures were intentional in preparation for increases in COVID-19–related volume, 1 National Syndromic Surveillance Program data indicate that weekly emergency department (ED) visits decreased 42% during the early stages of the pandemic. 2 This reduction may have been driven by a public fear of seeking care, 3, 4 ultimately delaying interventions for time-sensitive serious conditions. A group of US hospitals recently reported a 38% reduction in ST-elevation myocardial infarction (STEMI) activations, 5 and a national neuroimaging database indicated a 39% reduction in patients undergoing stroke imaging. 6 To yield a more complete picture of the COVID-19 pandemic’s effect on emergency care, we sought to describe ED visit trends for other serious diagnoses requiring acute intervention or hospitalization. We conducted a cross-sectional study of adult visits to seven EDs in a large health system located in greater Chicago, Illinois, with a combined 2019 visit volume of 308,000. These seven EDs include one urban academic hospital, five suburban community hospitals, and one free-standing ED. Additional hospital characteristics are included in Data Supplement S1, Appendix S1 (, available as supporting information in the online version of this paper, which is available at http://onlinelibrary. wile y. com/doi/10.1111/acem. 14099/full) We measured ED visit frequencies for serious diagnoses during the early stages of the COVID-19 pandemic (March 8 to May 2, 2020), a period of time encompassing the World Health Organization pandemic declaration on March 11, 2020, up to the date of data collection. We then compared this early pandemic period to a prepandemic period (December 31, 2019, to March 7, 2020) and a historical control period from the prior year (March 10, 2019, to April 27, 2019). Thus, the total study duration spanned from March 10, 2019, to May 2, 2020. This study was approved by the Northwestern University Institutional Review Board. We selected a limited set of serious diagnoses associated with the need for emergency care by multiple rounds of consensus-driven discussion. This process was guided by the priority selection of conditions requiring time-sensitive intervention (eg, acute myocardial infarction) or the need for timely therapy to prevent clinical deterioration (eg, gastrointestinal hemorrhage). We were additionally guided by the need to limit the overall number of diagnoses to preserve meaningful data visualization and to minimize the risk of achieving statistical significance through multiple comparisons alone. We did not include symptom-based diagnoses (eg, chest pain) given that these are nonspecific by definition.