Decreased hospital admissions through emergency departments during the COVID-19 pandemic.
Decreased hospital admissions through emergency departments during the COVID-19 pandemic.
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DOI：
10.1016/j.ajem.2020.11.029
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发表时间：
2021-04
期刊：
影响因子：
--
通讯作者：
Sanchez LD
中科院分区：
文献类型：
--
作者：
Nourazari S;Davis SR;Granovsky R;Austin R;Straff DJ;Joseph JW;Sanchez LD
在 COVID-19 大流行期间，美国急诊室 (ED) 就诊人数大幅减少。这种下降的一个令人不安的比例是在通常会入院的患者中，这表明护理被大量推迟。我们试图通过急诊室描述和描述 COVID-19 对入院的影响，特别关注诊断组、年龄、性别和保险范围。我们对第三方匿名急诊科患者数据进行了回顾性观察研究。该数据包括2019年1月1日至2019年9月9日以及2020年1月1日至2020年9月8日期间来自马萨诸塞州12个急诊室的501,369名患者就诊。我们分析了总入境人数和入院人数，并计算了每个特征入院人数变化的置信区间。然后，我们开发了一个泊松回归模型来估计全州封锁后每个特征对入学人数减少的相对贡献，对应于第 11 周至第 36 周（2020 年 3 月 11 日至 2020 年 9 月 8 日）。我们观察到 2020 年第 11 周至第 36 周的入院人数减少了 32%，其中因慢性呼吸系统疾病和非骨科需求而入院的人数显着减少。妇女和儿童以及有医疗保险或没有保险的患者的下降尤其严重。这段时间最常见的诊断是 SARS-CoV-2。我们的研究结果表明，大流行期间通过急诊室入院的人数有所减少，并表明一些患者群体可能推迟了必要的护理。需要进一步的研究来确定这种延迟的临床和操作后果。
Emergency Department (ED) visits decreased significantly in the United States during the COVID-19 pandemic. A troubling proportion of this decrease was among patients who typically would have been admitted to the hospital, suggesting substantial deferment of care. We sought to describe and characterize the impact of COVID-19 on hospital admissions through EDs, with a specific focus on diagnosis group, age, gender, and insurance coverage. We conducted a retrospective, observational study of aggregated third-party, anonymized ED patient data. This data included 501,369 patient visits from twelve EDs in Massachusetts from 1/1/2019–9/9/2019, and 1/1/2020–9/8/2020. We analyzed the total arrivals and hospital admissions and calculated confidence intervals for the change in admissions for each characteristic. We then developed a Poisson regression model to estimate the relative contribution of each characteristic to the decrease in admissions after the statewide lockdown, corresponding to weeks 11 through 36 (3/11/2020–9/8/2020). We observed a 32% decrease in admissions during weeks 11 to 36 in 2020, with significant decreases in admissions for chronic respiratory conditions and non-orthopedic needs. Decreases were particularly acute among women and children, as well as patients with Medicare or without insurance. The most common diagnosis during this time was SARS-CoV-2. Our findings demonstrate decreased hospital admissions through EDs during the pandemic and suggest that several patient populations may have deferred necessary care. Further research is needed to determine the clinical and operational consequences of this delay.
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