Trends in Emergency Department Visits and Hospital Admissions in Health Care Systems in 5 States in the First Months of the COVID-19 Pandemic in the US
Trends in Emergency Department Visits and Hospital Admissions in Health Care Systems in 5 States in the First Months of the COVID-19 Pandemic in the US
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DOI：
10.1001/jamainternmed.2020.3288
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发表时间：
2020-10-01
影响因子：
39
通讯作者：
Melnick, Edward R.
中科院分区：
文献类型：
--
作者：
Jeffery, Molly M.;D'Onofrio, Gail;Melnick, Edward R.
随着2019年冠状病毒病(新冠肺炎)在2020年前几个月在美国蔓延，急性护理服务发生了变化，以适应一种高传染性感染的患者的涌入，而这种高传染性感染的患者对此知之甚少。目的检查急诊科就诊和就诊的趋势，这些就诊和就诊导致在美国新冠肺炎爆发之前和期间的4个月期间住院。设计背景和参与者这项对科罗拉多州(n=4)，康涅狄格州(n=5)，马萨诸塞州(n=5)，纽约(n=5)和北卡罗来纳州(n=5)检查了2020年1月1日至4月30日期间每日急诊率和住院率与全国和5个州的新冠肺炎病例计数的关系。暴露时间(日)作为连续变量。主要结果和衡量每日急诊室就诊、住院和新冠肺炎病例的计数。在新冠肺炎大流行之前，每年急诊量在13 000至115 000人次之间；急诊量下降幅度从科罗拉多州的41.5%到纽约的63.5%不等。就诊量下降速度最快的一周是2020年3月，这与有关新冠肺炎的全国性公共卫生信息相对应。急诊科的住院率一直保持稳定，直到新发新冠肺炎病例在当地开始增加；住院率相对增幅最大的是纽约州149.0%，其次是马萨诸塞州51.7%，康涅狄格州36.2%，科罗拉多州29.4%，北卡罗来纳州22.0%。结论：从2020年1-4月，随着新冠肺炎在美国的流行加剧，急诊室就诊次数减少，5个州的5个医疗保健系统的住院率增加，观察到了时间相关性。这些发现表明，从业者和公共卫生官员应该强调，在新冠肺炎大流行期间，对于在其他环境下无法处理的严重症状、疾病和伤害，应前往急诊室就诊。
IMPORTANCE As coronavirus disease 2019 (COVID-19) spread throughout the US in the early months of 2020, acute care delivery changed to accommodate an influx of patients with a highly contagious infection about which little was known.OBJECTIVE To examine trends in emergency department (ED) visits and visits that led to hospitalizations covering a 4-month period leading up to and during the COVID-19 outbreak in the US.DESIGN, SETTING, AND PARTICIPANTS This retrospective, observational, cross-sectional study of 24 EDs in 5 large health care systems in Colorado (n = 4), Connecticut (n = 5), Massachusetts (n = 5), New York (n = 5), and North Carolina (n = 5) examined daily ED visit and hospital admission rates from January 1 to April 30, 2020, in relation to national and the 5 states' COVID-19 case counts.EXPOSURES Time (day) as a continuous variable.MAIN OUTCOMES AND MEASURES Daily counts of ED visits, hospital admissions, and COVID-19 cases.RESULTS A total of 24 EDs were studied. The annual ED volume before the COVID-19 pandemic ranged from 13 000 to 115 000 visits per year; the decrease in ED visits ranged from 41.5% in Colorado to 63.5% in New York. The weeks with the most rapid rates of decrease in visits were in March 2020, which corresponded with national public health messaging about COVID-19. Hospital admission rates from the ED were stable until new COVID-19 case rates began to increase locally; the largest relative increase in admission rates was 149.0% in New York, followed by 51.7% in Massachusetts, 36.2% in Connecticut, 29.4% in Colorado, and 22.0% in North Carolina.CONCLUSIONS AND RELEVANCE From January through April 2020, as the COVID-19 pandemic intensified in the US, temporal associations were observed with a decrease in ED visits and an increase in hospital admission rates in 5 health care systems in 5 states. These findings suggest that practitioners and public health officials should emphasize the importance of visiting the ED during the COVID-19 pandemic for serious symptoms, illnesses, and injuries that cannot be managed in other settings.