Corona-Independent Excess Mortality Due to Reduced Use of Emergency Medical Care in the Corona Pandemic: A Population-Based Observational Study
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Abstract
Background
A significant decrease in the number of cases of emergency medical care during the first phase of the Corona pandemic has been reported from various regions of the world. Due to the lack of or delayed use of medical assistance, particularly in the case of time-critical clinical pictures (myocardial infarction, stroke), a corona collateral damage syndrome is postulated regarding possible health consequences. The present study investigates changes in the use of preclinical and clinical emergency care and effects on overall mortality in a rural area.
Methods
The number of patients in the emergency department at the Klinikum Hochrhein and the ambulance service were retrospectively aggregated and analyzed regarding the total number and selected tracer diagnoses and alarm keywords. The investigation period was the 9th to 22nd calendar week 2020 compared to the identical period of the previous year. In addition, the death rates in the district were collected directly from the registries and related to the number of patients in emergency care.
Results
Overall, the number of patients in clinical and preclinical emergency care declined significantly during the investigation period. This concerned in particular emergency inpatient treatment of patients with exacerbations or complications of severe chronic diseases. At the same time, excess mortality occurred in April 2020, which was still highly significant even after excluding deaths on or with COVID-19.
Discussion
Only about 55 % of the excess mortality in April 2020 can be attributed to COVID-19 and is associated with the decline in inpatient emergency treatment, especially of chronically ill patients. Since a drift of patients with the use of other service providers is unlikely, we assume that fears of infection in overburdened hospitals, one-sided public communication and reporting, and the extent of contact restrictions have contributed significantly to the decline in case numbers and to excess mortality (collateral damage).
Conclusion
For similar situations in the future, it is strongly recommended to make crisis communication and media coverage more balanced so as not to prevent people with acute health problems from receiving medical assistance. Contact restrictions should be critically reviewed and limited to the objectively necessary minimum.
Article activity feed
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SciScore for 10.1101/2020.10.27.20220558: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not 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:Limitations: The present study is a retrospective monocentric analysis of aggregated data obtained from various IT systems. In particular, it must be considered that the treatment diagnoses coded in the emergency department and …
SciScore for 10.1101/2020.10.27.20220558: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not 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:Limitations: The present study is a retrospective monocentric analysis of aggregated data obtained from various IT systems. In particular, it must be considered that the treatment diagnoses coded in the emergency department and the alarm keywords assigned by the integrated control center are not congruent even in their systematics and therefore a direct comparison is not possible. However, due to the structure of our supply area (one local authority with one integrated control center and one acute hospital providing sole care), the study is a complete survey for the period under review, which also allows appropriate conclusions to be drawn due to the strength of the effects observed. Migration or shifts in acute medical care to other service providers cannot be ruled out with absolute certainty but appear very unlikely due to the care structure and physical distances to alternative treatment facilities. Likewise, it cannot be excluded that regionally significant developments and events have influenced the results and limit an uncritical transfer to other supply areas. A causality between the reduced use of acute medical care by chronically ill patients and the excess mortality in April 2020 established independently of COVID-19 seems very plausible but cannot be proven with absolute certainty from the available data. The same applies to the individual reasons for reduced use, where further research should follow.
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.
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SciScore for 10.1101/2020.10.27.20220558: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not 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:
Limitations The present study is a retrospective monocentric analysis of aggregated data obtained from various IT systems. In particular, it must be considered that the treatment diagnoses coded in the emergency department …
SciScore for 10.1101/2020.10.27.20220558: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not 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:
Limitations The present study is a retrospective monocentric analysis of aggregated data obtained from various IT systems. In particular, it must be considered that the treatment diagnoses coded in the emergency department and the alarm keywords assigned by the integrated control center are not congruent even in their systematics and therefore a direct comparison is not possible. However, due to the structure of our supply area (one local authority with one integrated control center and one acute hospital providing sole care), the study is a complete survey for the period under review, which also allows appropriate conclusions to be drawn due to the strength of the effects observed. Migration or shifts in acute medical care to other service providers cannot be ruled out with absolute certainty but appear very unlikely due to the care structure and physical distances to alternative treatment facilities. Likewise, it cannot be excluded that regionally significant developments and events have influenced the results and limit an uncritical transfer to other supply areas. A causality between the reduced use of acute medical care by chronically ill patients and the excess mortality in April 2020 established independently of COVID-19 seems very plausible but cannot be proven with absolute certainty from the available data. The same applies to the individual reasons for reduced use, where further research should follow.
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.
About SciScore
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