A short report: Acute, non-COVID related medical admissions during the first wave of COVID-19: A retrospective comparison of changing patterns of disease

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Abstract

Background

The COVID-19 pandemic was associated with social restrictions in the UK from 16 th March 2020. It was unclear if the lockdown period was associated with differences in the case-mix of non-COVID acute medical admissions compared with the previous year.

Methods

Retrospective data were collected for 1 st -30 th April 2019 and 1 st –30 th April 2020 from University Hospitals Birmingham NHS Foundation Trust, one of the largest hospitals in the UK with over 2 million patient contacts per year. The latter time period was chosen to coincide with the peak of COVID-19 cases in the West Midlands. All patients admitted under acute medicine during these time periods were included. COVID-19 was confirmed by SARS-Cov-2 swab or a probable case of COVID-19 based on World Health Organization diagnostic parameters. Non-COVID patients were those with a negative SARS-Cov-2 swab and no suspicion of COVID-19. Data was sourced from UHB’s in-house electronic health system (EHS).

Results

The total number of acute medical admissions fell comparing April 2019 (n = 2409) to April 2020 (n = 1682). As a proportion of total admissions, those aged under 45 years decreased, while those aged 46 and over did not change.

The number of admissions due to psychiatric conditions and overdoses was higher in April 2020 (p < 0.001). When viewed as a proportion of admissions, alcohol-related admissions (p = 0.004), psychiatric conditions and overdoses (p< 0.001) increased in April 2020 than in April 2019. The proportion of patients who were in hospital due to falls also increased in April 2020 (p< 0.001). In the same period, the absolute number and the proportion of admissions that were due to non-specific chest pain, to musculoskeletal complaints and patients who self-discharged prior to assessment decreased (p = 0.02, p = 0.01 and p = 0.002 respectively).

There were no significant differences in non-COVID-related intensive care admissions or mortality between the same months in the two years.

Conclusion

In this large, single-centre study, there was a change in hospitalised case-mix when comparing April 2019 with April 2020: an increase in conditions which potentially reflect social isolation (falls, drug and alcohol misuse and psychiatric illness) and a decrease in conditions which rarely require in-patient hospital treatment (musculoskeletal pain and non-cardiac chest pain) especially among younger adults. These results highlight two areas for further research; the impact of social isolation on health and whether younger adults could be offered alternative health services to avoid potentially unnecessary hospital assessment.

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  1. SciScore for 10.1101/2020.09.15.20194795: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analysis was performed using SPSS, version 26 (IBM).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    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:
    This study has limitations. This is a single centre analysis. Patients were excluded if admitted directly to a specialty. These admission routes were available prior to April 2019, so will not affect comparison between years described here. However, centres without these admission routes may have a different alteration in the profile of admissions.

    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.