Characteristics of patients presenting, and not presenting, to the emergency department during the early days of COVID-19

  1. Bjorn C. Westgard
  2. Matthew W. Morgan
  3. Gabriela Vazquez-Benitez
  4. Lauren O. Erickson
  5. Michael D. Zwank

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

Objective

Societal responses to the COVID-19 pandemic have had a substantial effect upon the number of patients seeking healthcare. An initial step in estimating the impact of these changes is characterizing the patients, visits, and diagnoses for whom care is being delayed or deferred.

Methods

We conducted an observational study, examining demographics and diagnoses for all patient visits to the ED of an urban Level-1 trauma center before and after the state declaration and compared them to visits from a similar period in 2019. We estimated the ratios of the before and after periods using Poisson regression, calculated the percent change with respect to 2019 for total ED visits, patient characteristics, and diagnoses, and then evaluated the interactions between each factor and the overall change in ED visits.

Results

There was a significant 35.2% drop in overall ED visits after the state declaration. Disproportionate declines were seen in visits by pediatric and older patients, women, and Medicare recipients as well as for presentations of syncope, cerebrovascular accidents, urolithiasis, abdominal and back pain. Significantly disproportionate increases were seen in ED visits for potential symptoms of COVID-19, including URIs, shortness of breath, and chest pain.

Conclusions

Patient concerns about health care settings and public health have significantly altered care-seeking during the COVID-19 pandemic. Overall and differential declines in ED visits for certain demographic groups and disease processes should prompt efforts to encourage care-seeking and research to monitor for the morbidity and mortality that is likely to result from delayed or deferred care.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2020.05.05.20090795: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: Data were collected as part of institutional operations and quality improvement and were therefore deemed by the institutional review board to be exempt from review.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    In spite of those limitations, we have found notable differential changes in the demographic factors, visits characteristics, and diagnoses of presentations to the ED unrelated to COVID-19. These will no doubt change along with the burdens of care as the pandemic progresses. Further efforts should and are being made to reassure and affirm the appropriateness of seeking emergency care9, particularly for the groups and disease processes that have been highlighted here and elsewhere4,5. Further research will also be needed to examine these and other factors contributing to delayed or deferred care and to monitor for the morbidity and mortality that is likely to result5,8 and which may already be occurring10.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.05.05.20090795v1 on medRxiv